- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $67.61 / $109.65
| Facility | | $19.05 | $67.61 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $10.47 / $10.47
| Facility | 26 | $5.62 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $21.88 / $43.65
| Professional | | $10.96 | $21.88 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $7.94 / $11.48
| Professional | 26 | $3.02 | $7.94 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.94 / $17.78 / $32.36
| Professional | TC | $7.94 | $17.78 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $15.85
| Facility | | $14.45 | $14.45 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $16.60 / $21.38
| Professional | | $11.75 | $16.60 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $4.27 / $6.17
| Professional | 26 | $3.02 | $4.27 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.71 / $9.33 / $12.30
| Professional | TC | $8.71 | $9.33 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Facility | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $21.38 / $34.67
| Professional | | $8.13 | $21.38 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $6.03 / $7.59
| Professional | 26 | $2.29 | $6.03 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.75 / $15.14 / $28.84
| Professional | TC | $5.75 | $15.14 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $16.60 / $26.30
| Professional | | $9.33 | $16.60 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.09 / $4.79 / $7.08
| Professional | 26 | $2.09 | $4.79 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.24 / $14.13 / $18.62
| Professional | TC | $7.24 | $14.13 | $18.62 |