- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $38.90
| Professional | | $10.96 | $14.13 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $7.08 / $15.14
| Professional | 26 | $3.02 | $7.08 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $27.54
| Professional | TC | $7.08 | $10.00 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $2.63 / $6.17
| Professional | 26 | $1.95 | $2.63 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $19.50 / $25.70
| Professional | | $9.77 | $19.50 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $5.75 / $7.59
| Professional | 26 | $4.57 | $5.75 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.88 / $14.45 / $19.05
| Professional | TC | $2.88 | $14.45 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $11.75 / $19.05
| Facility | | $4.07 | $11.75 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $13.49 / $20.42
| Professional | | $4.37 | $13.49 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $41.69
| Facility | | $11.22 | $15.85 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $14.79 / $32.36
| Professional | | $6.76 | $14.79 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.09 / $4.07 / $9.55
| Professional | 26 | $2.09 | $4.07 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.57 / $10.00 / $24.55
| Professional | TC | $4.57 | $10.00 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.94 / $13.18
| Facility | | $5.25 | $7.94 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $17.38 / $29.51
| Professional | | $9.55 | $17.38 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.75 / $4.68 / $9.12
| Professional | 26 | $2.75 | $4.68 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $13.18 / $21.38
| Professional | TC | $6.76 | $13.18 | $21.38 |