- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $28.84 / $194.98
| Facility | | $27.54 | $28.84 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $31.62
| Professional | | $12.02 | $15.14 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $9.12 / $12.59
| Professional | 26 | $3.02 | $9.12 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $10.96 / $22.91
| Professional | TC | $6.03 | $10.96 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Facility | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $14.79 / $35.48
| Professional | | $8.32 | $14.79 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $3.63 / $7.59
| Professional | 26 | $2.14 | $3.63 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $11.22 / $22.91
| Professional | TC | $6.03 | $11.22 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $32.36 / $45.71
| Professional | | $16.22 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.27 / $8.51 / $12.02
| Professional | 26 | $4.27 | $8.51 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $23.99 / $33.88
| Professional | TC | $11.75 | $23.99 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $24.55 / $53.70
| Facility | | $15.85 | $24.55 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $30.90 / $52.48
| Professional | | $16.60 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.27 / $7.94 / $14.45
| Professional | 26 | $4.27 | $7.94 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $23.44 / $37.15
| Professional | TC | $11.48 | $23.44 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $20.89 / $32.36
| Facility | | $8.51 | $20.89 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $8.71 / $19.05
| Professional | | $6.46 | $8.71 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $24.55 / $47.86
| Facility | | $15.85 | $24.55 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $28.84 / $48.98
| Professional | | $11.75 | $28.84 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.34 / $4.47 / $12.59
| Professional | 26 | $2.34 | $4.47 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $12.59 / $35.48
| Professional | TC | $6.03 | $12.59 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $107.15
| Facility | | $104.71 | $104.71 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $52.48
| Professional | | $21.38 | $31.62 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.12 / $13.80
| Professional | 26 | $6.31 | $9.12 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $22.39 / $38.02
| Professional | TC | $15.49 | $22.39 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $13.80 / $51.29
| Professional | | $9.55 | $13.80 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $7.08 / $19.05
| Professional | 26 | $2.82 | $7.08 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $38.90
| Professional | TC | $6.76 | $11.22 | $38.90 |