- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $87.10
| Facility | | $63.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $14.79 / $41.69
| Professional | | $8.91 | $14.79 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.61 / $12.02
| Professional | 26 | $3.02 | $6.61 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.92 / $10.00 / $33.88
| Professional | TC | $6.92 | $10.00 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $7.41
| Professional | | $7.41 | $7.41 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.17
| Professional | 26 | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $10.72
| Professional | TC | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.05 / $42.66
| Professional | | $12.88 | $19.05 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.98 / $7.08 / $20.89
| Professional | 26 | $3.98 | $7.08 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.71 / $12.30 / $30.20
| Professional | TC | $8.71 | $12.30 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.98 / $34.67
| Professional | | $14.79 | $16.98 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.07 / $5.37 / $7.59
| Professional | 26 | $4.07 | $5.37 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $12.30 / $26.92
| Professional | TC | $10.72 | $12.30 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $12.30 / $51.29
| Professional | | $7.24 | $12.30 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.09 / $2.82 / $25.70
| Professional | 26 | $2.09 | $2.82 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.13 / $9.55 / $40.74
| Professional | TC | $5.13 | $9.55 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $17.38 / $50.12
| Facility | | $13.49 | $17.38 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $25.12 / $123.03
| Professional | | $9.55 | $25.12 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $6.03 / $87.10
| Professional | 26 | $2.82 | $6.03 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $17.78 / $97.72
| Professional | TC | $6.76 | $17.78 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $6.03 / $8.13
| Facility | | $2.09 | $6.03 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $15.85 / $36.31
| Professional | | $9.55 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $4.68 / $11.22
| Professional | 26 | $2.82 | $4.68 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $25.12
| Professional | TC | $6.76 | $11.22 | $25.12 |