- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $18.20 / $87.10
| Professional | | $10.96 | $18.20 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $8.71 / $19.05
| Professional | 26 | $3.02 | $8.71 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.94 / $12.88 / $74.13
| Professional | TC | $7.94 | $12.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $14.45
| Professional | 26 | $2.19 | $2.19 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $24.55 / $34.67
| Professional | | $11.22 | $24.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $7.08 / $9.55
| Professional | 26 | $1.86 | $7.08 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.55 / $17.38 / $23.44
| Professional | TC | $9.55 | $17.38 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $16.60 / $45.71
| Professional | | $8.32 | $16.60 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.09 / $4.47 / $12.88
| Professional | 26 | $2.09 | $4.47 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.17 / $11.48 / $36.31
| Professional | TC | $6.17 | $11.48 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $22.91 / $51.29
| Professional | | $13.49 | $22.91 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $6.03 / $12.02
| Professional | 26 | $5.13 | $6.03 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $21.38 / $38.02
| Professional | TC | $13.80 | $21.38 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $22.39 / $58.88
| Professional | | $16.22 | $22.39 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.68 / $7.08 / $85.11
| Professional | 26 | $4.68 | $7.08 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $33.11
| Professional | TC | $11.22 | $15.85 | $33.11 |