- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $47.86
| Professional | | $18.20 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $97.72
| Professional | 26 | $15.14 | $33.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.98 / $6.03 / $13.18
| Professional | TC | $3.98 | $6.03 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.18 / $57.54
| Professional | | $16.22 | $28.18 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $22.39 / $43.65
| Professional | 26 | $12.02 | $22.39 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.17 / $6.46 / $14.45
| Professional | TC | $4.17 | $6.46 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $43.65
| Professional | | $21.88 | $28.84 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $30.20
| Professional | 26 | $15.14 | $19.95 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.61 / $8.91 / $13.49
| Professional | TC | $6.61 | $8.91 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $56.23
| Professional | | $19.95 | $26.92 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $46.77
| Professional | 26 | $15.14 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.13 / $8.32 / $14.79
| Professional | TC | $5.13 | $8.32 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $39.81
| Professional | | $14.45 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $17.78 / $30.20
| Professional | 26 | $10.00 | $17.78 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.80 / $6.31 / $10.72
| Professional | TC | $3.80 | $6.31 | $10.72 |