- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $17.38
| Facility | 26 | $10.96 | $10.96 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $77.62 / $114.82
| Facility | TC | $25.12 | $77.62 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $208.93
| Professional | | $30.90 | $40.74 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $33.11
| Professional | 26 | $10.00 | $12.88 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $70.79
| Professional | TC | $20.89 | $26.30 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Facility | TC | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $100.00 / $125.89
| Professional | | $39.81 | $100.00 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $30.20 / $38.02
| Professional | 26 | $15.14 | $30.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $69.18 / $87.10
| Professional | TC | $25.12 | $69.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $186.21
| Professional | | $41.69 | $72.44 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $61.66
| Professional | 26 | $12.30 | $17.78 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $93.33
| Professional | TC | $25.70 | $38.02 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $70.79
| Facility | 26 | $45.71 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $131.83
| Facility | TC | $81.28 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $66.07 / $269.15
| Professional | | $38.90 | $66.07 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $81.28
| Professional | 26 | $13.49 | $18.20 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $190.55
| Professional | TC | $23.99 | $33.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $147.91
| Professional | | $70.79 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $29.51 / $54.95
| Professional | 26 | $26.30 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $61.66 / $91.20
| Professional | TC | $44.67 | $61.66 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Facility | TC | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $147.91
| Professional | | $83.18 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $54.95
| Professional | 26 | $26.30 | $32.36 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $69.18 / $91.20
| Professional | TC | $56.23 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $29.51 / $69.18
| Professional | | $13.18 | $29.51 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $107.15
| Professional | | $38.90 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $20.42 / $60.26
| Professional | 26 | $13.49 | $20.42 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $61.66
| Professional | TC | $23.99 | $30.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $85.11
| Professional | | $72.44 | $72.44 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $26.30
| Professional | 26 | $22.39 | $22.39 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $58.88
| Professional | TC | $50.12 | $50.12 | $58.88 |