- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $15.85 / $28.18
| Professional | | $8.91 | $15.85 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $5.01 / $12.02
| Professional | 26 | $3.02 | $5.01 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $12.02 / $19.95
| Professional | TC | $6.03 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $38.90
| Professional | | $10.00 | $16.22 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $5.25 / $9.33
| Professional | 26 | $2.14 | $5.25 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.13 / $12.59 / $28.18
| Professional | TC | $8.13 | $12.59 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.50 / $23.44
| Professional | | $16.22 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.68 / $5.25 / $7.76
| Professional | 26 | $4.68 | $5.25 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $14.45 / $15.85
| Professional | TC | $11.48 | $14.45 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $28.84
| Professional | | $16.98 | $24.55 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $6.61 / $8.13
| Professional | 26 | $4.37 | $6.61 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $17.78 / $20.89
| Professional | TC | $12.59 | $17.78 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $10.96 / $28.84
| Professional | | $4.57 | $10.96 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $15.85 / $29.51
| Professional | | $9.55 | $15.85 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.57 / $4.37 / $7.08
| Professional | 26 | $2.57 | $4.37 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $22.39
| Professional | TC | $6.76 | $11.22 | $22.39 |