- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $812.83
| Facility | | $38.90 | $57.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.22 / $67.61
| Professional | | $10.96 | $16.22 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $9.12 / $17.38
| Professional | 26 | $3.02 | $9.12 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.92 / $10.23 / $33.11
| Professional | TC | $6.92 | $10.23 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $15.49 / $19.05
| Professional | | $9.77 | $15.49 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.55 / $4.17 / $4.90
| Professional | 26 | $3.55 | $4.17 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $11.48 / $14.79
| Professional | TC | $10.96 | $11.48 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $40.74
| Professional | | $7.08 | $10.00 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.05 / $2.51 / $7.59
| Professional | 26 | $0.05 | $2.51 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.14 / $7.08 / $23.99
| Professional | TC | $0.14 | $7.08 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $20.89 / $28.18
| Professional | | $17.38 | $20.89 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $5.75 / $9.77
| Professional | 26 | $4.57 | $5.75 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $15.49 / $20.89
| Professional | TC | $12.88 | $15.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $16.60 / $31.62
| Professional | | $11.22 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $3.72 / $8.71
| Professional | 26 | $2.82 | $3.72 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $22.91
| Professional | TC | $7.94 | $12.02 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $27.54
| Professional | | $16.98 | $24.55 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.79 / $6.17 / $6.92
| Professional | 26 | $4.79 | $6.17 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $18.20 / $20.42
| Professional | TC | $12.30 | $18.20 | $20.42 |