- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $41.69 / $97.72
| Facility | | $13.80 | $41.69 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $17.78 / $48.98
| Facility | 26 | $10.47 | $17.78 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.92 / $25.70 / $95.50
| Facility | TC | $6.92 | $25.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.50 / $52.48
| Professional | | $13.49 | $19.50 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $24.55 / $75.86
| Professional | 26 | $8.91 | $24.55 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.01 / $7.08 / $20.89
| Professional | TC | $5.01 | $7.08 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Facility | | $6.46 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $19.05 / $46.77
| Professional | | $9.12 | $19.05 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $13.18 / $29.51
| Professional | 26 | $5.37 | $13.18 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.24 / $5.25 / $17.38
| Professional | TC | $3.24 | $5.25 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $23.44 / $151.36
| Facility | | $14.13 | $23.44 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $16.98 / $40.74
| Facility | 26 | $3.16 | $16.98 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $10.72 / $30.90
| Facility | TC | $2.00 | $10.72 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $18.62 / $38.90
| Professional | | $9.12 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $11.75 / $25.12
| Professional | 26 | $5.75 | $11.75 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.24 / $6.31 / $15.85
| Professional | TC | $3.24 | $6.31 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $10.96 / $18.20
| Facility | | $5.25 | $10.96 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $21.38 / $53.70
| Professional | | $11.48 | $21.38 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $12.88 / $56.23
| Professional | 26 | $6.92 | $12.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.37 / $7.94 / $17.38
| Professional | TC | $4.37 | $7.94 | $17.38 |