- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $25.12 / $44.67
| Professional | | $19.50 | $25.12 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $25.12
| Professional | 26 | $15.85 | $19.95 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $25.70
| Professional | TC | $3.02 | $3.98 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $40.74 / $67.61
| Professional | | $21.38 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $27.54 / $36.31
| Professional | 26 | $17.78 | $27.54 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.09 / $8.32 / $29.51
| Professional | TC | $3.09 | $8.32 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $57.54 / $81.28
| Professional | | $26.30 | $57.54 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $46.77
| Professional | 26 | $19.50 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.37 / $14.79 / $48.98
| Professional | TC | $4.37 | $14.79 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $72.44
| Professional | | $28.84 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $33.11
| Professional | 26 | $23.99 | $28.84 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.25 / $7.76 / $43.65
| Professional | TC | $5.25 | $7.76 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $70.79
| Professional | | $20.89 | $31.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $23.99 / $42.66
| Professional | 26 | $17.38 | $23.99 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.63 / $5.50 / $40.74
| Professional | TC | $3.63 | $5.50 | $40.74 |