- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $64.57
| Facility | | $6.76 | $31.62 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $46.77 / $60.26
| Facility | 26 | $30.20 | $46.77 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $46.77 / $56.23
| Professional | | $19.95 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $45.71 / $158.49
| Professional | 26 | $22.39 | $45.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Professional | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $102.33
| Facility | | $32.36 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $46.77 / $56.23
| Professional | | $10.96 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $38.02 / $52.48
| Professional | 26 | $18.20 | $38.02 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $9.55 / $18.62
| Facility | | $6.17 | $9.55 | $18.62 |
- 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
- $21.38 / $51.29 / $87.10
| Facility | | $21.38 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.16 / $3.16
| Facility | | $2.95 | $3.16 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $23.44 / $57.54
| Professional | | $16.22 | $23.44 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $23.44 / $53.70
| Professional | 26 | $16.22 | $23.44 | $53.70 |