- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $44.67
| Professional | | $10.00 | $16.22 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $9.12 / $22.39
| Professional | 26 | $3.02 | $9.12 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $28.84
| Professional | TC | $7.08 | $9.55 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $15.14 / $16.98
| Professional | | $5.50 | $15.14 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.72 / $4.17 / $4.17
| Professional | 26 | $3.72 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $15.49
| Professional | TC | $11.48 | $11.48 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $9.77 / $67.61
| Professional | | $7.24 | $9.77 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $2.57 / $30.20
| Professional | 26 | $2.00 | $2.57 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $7.41 / $50.12
| Professional | TC | $5.37 | $7.41 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.90 / $38.90
| Professional | | $21.88 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $9.77 / $9.77
| Professional | 26 | $5.50 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $28.84 / $28.84
| Professional | TC | $16.22 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $30.20 / $95.50
| Professional | | $10.23 | $30.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $7.59 / $18.62
| Professional | 26 | $3.02 | $7.59 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $8.91 / $23.44
| Professional | TC | $6.76 | $8.91 | $23.44 |