- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $75.86
| Facility | | $27.54 | $27.54 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | 26 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $47.86
| Professional | | $10.96 | $15.14 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.61 / $23.44
| Professional | 26 | $3.02 | $6.61 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $29.51
| Professional | TC | $7.08 | $10.23 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.00 / $16.22
| Professional | | $8.13 | $10.00 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $6.03 / $12.88
| Professional | 26 | $2.29 | $6.03 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $7.24
| Professional | TC | $7.24 | $7.24 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $17.78 / $25.12
| Professional | | $10.00 | $17.78 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $12.59 / $29.51
| Professional | | $7.76 | $12.59 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.24 / $3.80 / $7.59
| Professional | 26 | $2.24 | $3.80 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $9.12 / $21.38
| Professional | TC | $5.62 | $9.12 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $19.50 / $41.69
| Professional | | $16.98 | $19.50 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.47 / $5.25 / $8.51
| Professional | 26 | $3.47 | $5.25 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $33.88
| Professional | TC | $11.75 | $13.80 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $32.36 / $33.11
| Professional | | $6.17 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $5.25 / $13.18
| Facility | | $1.78 | $5.25 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $13.18 / $38.02
| Professional | | $7.76 | $13.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.24 / $3.02 / $11.75
| Professional | 26 | $2.24 | $3.02 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.50 / $9.33 / $25.12
| Professional | TC | $5.50 | $9.33 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $12.88 / $16.98
| Professional | | $5.75 | $12.88 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.48 / $3.31 / $4.57
| Professional | 26 | $1.48 | $3.31 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.27 / $9.33 / $12.59
| Professional | TC | $4.27 | $9.33 | $12.59 |