- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $11.48 / $20.89
| Facility | | $3.09 | $11.48 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $87.10
| Facility | 26 | $69.18 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $44.67 / $64.57
| Professional | | $15.14 | $44.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $44.67 / $97.72
| Professional | 26 | $17.38 | $44.67 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $7.76 / $14.13
| Facility | | $1.74 | $7.76 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $41.69 / $281.84
| Professional | | $38.90 | $41.69 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $38.90 / $263.03
| Professional | 26 | $36.31 | $38.90 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $8.13 / $13.18
| Facility | | $5.25 | $8.13 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | 26 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $53.70 / $93.33
| Facility | | $25.70 | $53.70 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $223.87
| Facility | 26 | $87.10 | $87.10 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $302.00
| Professional | | $17.78 | $23.44 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $281.84
| Professional | 26 | $17.78 | $23.44 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $3.63
| Facility | | $2.82 | $2.82 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.42 / $64.57
| Professional | | $16.60 | $20.42 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $69.18
| Professional | 26 | $16.60 | $20.89 | $69.18 |