- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $6.61 / $12.59
| Facility | 26 | $5.75 | $6.61 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $61.66
| Professional | | $25.12 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $18.20
| Professional | 26 | $6.03 | $7.94 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $43.65
| Professional | TC | $19.05 | $25.70 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $79.43
| Professional | | $30.20 | $34.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $15.14
| Professional | 26 | $8.91 | $8.91 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $29.51 / $38.90
| Professional | | $6.76 | $29.51 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $61.66
| Professional | | $33.88 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $9.12
| Professional | 26 | $8.13 | $8.13 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $10.00 / $14.13
| Facility | 26 | $2.14 | $10.00 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $72.44
| Professional | | $27.54 | $38.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.23 / $19.05
| Professional | 26 | $7.24 | $10.23 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $56.23
| Professional | TC | $19.50 | $28.18 | $56.23 |
- 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
- $295.12 / $323.59 / $323.59
| Professional | | $295.12 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $70.79
| Professional | 26 | $54.95 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $281.84
| Professional | TC | $257.04 | $257.04 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $7.94 / $11.48
| Facility | 26 | $5.75 | $7.94 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $85.11
| Professional | | $25.12 | $40.74 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $19.95
| Professional | 26 | $6.03 | $10.00 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $63.10
| Professional | TC | $19.50 | $30.20 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $32.36 / $33.11
| Professional | | $7.24 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $104.71
| Professional | | $53.70 | $72.44 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $10.72 / $15.14
| Facility | 26 | $2.29 | $10.72 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $83.18
| Professional | | $26.92 | $38.90 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.33 / $16.98
| Professional | 26 | $7.24 | $9.33 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $50.12
| Professional | TC | $19.05 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $74.13
| Professional | | $28.84 | $35.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $8.91 / $20.42
| Professional | 26 | $7.59 | $8.91 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $43.65
| Professional | TC | $20.89 | $26.30 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $40.74 / $47.86
| Professional | | $38.90 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $9.12 / $10.96
| Professional | 26 | $8.71 | $9.12 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $31.62 / $37.15
| Professional | TC | $29.51 | $31.62 | $37.15 |