- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $56.23
| Facility | | $17.38 | $26.30 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $7.94
| Facility | 26 | $5.25 | $5.25 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $23.44 / $29.51
| Professional | | $15.49 | $23.44 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $5.37 / $24.55
| Professional | 26 | $3.02 | $5.37 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $18.62 / $23.44
| Professional | TC | $10.72 | $18.62 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $11.22 / $20.42
| Professional | | $3.98 | $11.22 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $29.51 / $40.74
| Professional | | $14.79 | $29.51 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $5.50 / $7.24
| Professional | 26 | $4.37 | $5.50 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $24.55 / $33.88
| Professional | TC | $10.72 | $24.55 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $38.90
| Facility | | $14.45 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $30.90 / $47.86
| Professional | | $15.14 | $30.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $5.75 / $7.24
| Professional | 26 | $4.37 | $5.75 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $24.55 / $33.88
| Professional | TC | $10.72 | $24.55 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $33.88
| Professional | | $9.55 | $14.45 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.57 / $2.82 / $8.91
| Professional | 26 | $2.57 | $2.82 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $23.44
| Professional | TC | $6.76 | $11.22 | $23.44 |