- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $8.91 / $120.23
| Facility | | $7.76 | $8.91 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Facility | 26 | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $27.54
| Professional | | $8.91 | $14.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $18.20
| Professional | 26 | $6.03 | $7.94 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $3.89 / $7.41
| Professional | TC | $2.00 | $3.89 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $11.22 / $22.91
| Professional | | $8.91 | $11.22 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $52.48 / $89.13
| Facility | | $27.54 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.13 / $20.89
| Professional | | $11.22 | $14.13 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $16.60
| Professional | 26 | $7.76 | $11.22 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.51 / $3.72 / $5.13
| Professional | TC | $2.51 | $3.72 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $72.44 / $257.04
| Facility | | $16.98 | $72.44 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $26.30
| Professional | | $11.22 | $15.85 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.22 / $18.20
| Professional | 26 | $7.94 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.24 / $4.79 / $8.71
| Professional | TC | $2.24 | $4.79 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.49 / $26.92
| Facility | | $10.00 | $15.49 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $120.23
| Facility | | $21.38 | $24.55 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $21.88
| Professional | | $10.47 | $13.18 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.12 / $15.49
| Professional | 26 | $7.08 | $9.12 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.95 / $3.98 / $6.61
| Professional | TC | $2.95 | $3.98 | $6.61 |