- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $19.05 / $29.51
| Facility | 26 | $12.88 | $19.05 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $66.07 / $436.52
| Facility | TC | $28.84 | $66.07 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $112.20
| Professional | | $36.31 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.95 / $52.48
| Professional | 26 | $10.96 | $19.95 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $79.43
| Professional | TC | $23.99 | $32.36 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $33.88
| Professional | | $28.84 | $33.11 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $15.85 / $17.78
| Professional | 26 | $10.23 | $15.85 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | TC | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $95.50
| Professional | | $43.65 | $58.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $36.31
| Professional | 26 | $16.98 | $22.39 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $57.54
| Professional | TC | $28.18 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $74.13
| Professional | | $52.48 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $23.44
| Professional | 26 | $16.60 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $51.29
| Professional | TC | $36.31 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $102.33
| Professional | | $37.15 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $19.50 / $34.67
| Professional | 26 | $12.30 | $19.50 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $69.18
| Professional | TC | $25.12 | $38.90 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $15.14 / $21.88
| Facility | 26 | $3.24 | $15.14 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.24 / $33.88 / $48.98
| Facility | TC | $7.24 | $33.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $93.33
| Professional | | $36.31 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $19.05 / $35.48
| Professional | 26 | $12.30 | $19.05 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $63.10
| Professional | TC | $25.12 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $33.11
| Professional | | $26.30 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | TC | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $95.50
| Professional | | $42.66 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $16.60 / $29.51
| Professional | 26 | $13.49 | $16.60 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $36.31 / $66.07
| Professional | TC | $29.51 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $91.20
| Professional | | $36.31 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $36.31
| Professional | 26 | $11.75 | $17.38 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $52.48
| Professional | TC | $22.91 | $31.62 | $52.48 |