- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.47 / $13.49
| Facility | 26 | $7.41 | $10.47 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $33.11 / $91.20
| Professional | | $13.80 | $33.11 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.49 / $33.88
| Professional | 26 | $7.08 | $13.49 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $154.88 / $398.11
| Professional | 50 | $69.18 | $154.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $58.88
| Professional | TC | $18.20 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $60.26
| Professional | | $25.12 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.59 / $14.79
| Professional | 26 | $6.17 | $7.59 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | 50 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $28.18 / $41.69
| Professional | TC | $15.49 | $28.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.18 / $47.86
| Professional | | $25.70 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.47 / $16.22
| Professional | 26 | $8.32 | $10.47 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $42.66 / $72.44
| Professional | 50 | $38.02 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $18.20 / $33.88
| Professional | TC | $17.38 | $18.20 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $26.92 / $39.81
| Professional | | $8.13 | $26.92 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $69.18
| Professional | | $25.12 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $17.78
| Professional | 26 | $6.92 | $10.47 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $52.48
| Professional | TC | $19.05 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $66.07
| Professional | | $25.70 | $31.62 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.12 / $17.78
| Professional | 26 | $7.41 | $9.12 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $22.91 / $43.65
| Professional | TC | $17.78 | $22.91 | $43.65 |