- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $9.33 / $26.92
| Facility | 26 | $5.01 | $9.33 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $67.61 / $151.36
| Facility | TC | $10.23 | $67.61 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $22.91 / $51.29
| Professional | | $13.80 | $22.91 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $8.91 / $25.70
| Professional | 26 | $5.01 | $8.91 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $45.71 / $89.13 / $194.98
| Professional | 50 | $45.71 | $89.13 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $31.62
| Professional | TC | $8.91 | $14.13 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $16.98 / $37.15
| Professional | | $14.45 | $16.98 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $7.08 / $12.88
| Professional | 26 | $5.62 | $7.08 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $10.72 / $24.55
| Professional | TC | $9.33 | $10.72 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $18.20
| Professional | | $11.75 | $14.79 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.82 / $8.32 / $14.45
| Facility | 26 | $1.82 | $8.32 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.31 / $15.49 / $22.39
| Facility | TC | $3.31 | $15.49 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $23.99 / $48.98
| Professional | | $14.79 | $23.99 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $8.51 / $16.98
| Professional | 26 | $5.25 | $8.51 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $16.98 / $34.67
| Professional | TC | $9.77 | $16.98 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $8.51
| Facility | 26 | $8.51 | $8.51 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.49
| Facility | TC | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.88 / $31.62
| Professional | | $14.79 | $21.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $7.41 / $10.72
| Professional | 26 | $5.25 | $7.41 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $14.13 / $20.89
| Professional | TC | $9.77 | $14.13 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $17.38 / $33.11
| Professional | | $5.75 | $17.38 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $45.71
| Professional | | $16.98 | $21.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $7.59 / $16.22
| Professional | 26 | $5.89 | $7.59 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $13.80 / $30.20
| Professional | TC | $10.47 | $13.80 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $22.39
| Professional | | $15.14 | $15.14 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $7.59
| Professional | 26 | $5.13 | $5.13 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $14.79
| Professional | TC | $10.00 | $10.00 | $14.79 |