- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $20.89 / $47.86
| Professional | | $9.77 | $20.89 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.03 / $24.55
| Professional | 26 | $3.02 | $6.03 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $15.14 / $30.20
| Professional | TC | $7.08 | $15.14 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.24
| Professional | 26 | $2.24 | $2.24 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.75 / $16.22
| Professional | | $11.22 | $11.75 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $3.24 / $4.47
| Professional | 26 | $3.16 | $3.24 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.13 / $8.51 / $11.75
| Professional | TC | $8.13 | $8.51 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $15.14 / $22.39
| Professional | | $7.76 | $15.14 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.09 / $4.27 / $6.92
| Professional | 26 | $2.09 | $4.27 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.13 / $10.72 / $18.20
| Professional | TC | $5.13 | $10.72 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $20.42 / $28.84
| Facility | | $13.49 | $20.42 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $15.85 / $123.03
| Professional | | $9.55 | $15.85 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.57 / $4.68 / $87.10
| Professional | 26 | $2.57 | $4.68 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $97.72
| Professional | TC | $6.76 | $11.22 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.94 / $13.18
| Facility | | $5.25 | $7.94 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $25.70
| Professional | | $9.55 | $14.45 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.51 / $3.63 / $28.84
| Professional | 26 | $2.51 | $3.63 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $17.78
| Professional | TC | $6.76 | $11.22 | $17.78 |