- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $8.51
| Facility | 26 | $7.08 | $7.08 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $13.18 / $75.86
| Facility | TC | $12.02 | $13.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $23.99 / $47.86
| Professional | | $15.14 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $25.12
| Professional | 26 | $6.03 | $8.91 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $107.15 / $109.65
| Professional | 50 | $100.00 | $107.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $28.84
| Professional | TC | $10.96 | $15.14 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.95 / $26.92
| Professional | | $15.49 | $19.95 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $5.75 / $8.51
| Professional | 26 | $5.50 | $5.75 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $10.47
| Professional | TC | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $23.44 / $43.65
| Professional | | $20.89 | $23.44 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $8.32 / $14.79
| Professional | 26 | $7.76 | $8.32 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $31.62 / $35.48 / $66.07
| Professional | 50 | $31.62 | $35.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $15.49 / $28.84
| Professional | TC | $13.80 | $15.49 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $14.45 / $25.12
| Professional | | $7.59 | $14.45 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.82 / $8.32 / $12.02
| Facility | 26 | $1.82 | $8.32 | $12.02 |
- 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
- $19.05 / $33.88 / $112.20
| Professional | | $19.05 | $33.88 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $12.02 / $36.31
| Professional | 26 | $6.76 | $12.02 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $23.44 / $67.61
| Professional | TC | $12.59 | $23.44 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $32.36 / $33.11
| Professional | | $12.88 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $24.55 / $38.90
| Professional | | $18.62 | $24.55 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.13 / $14.45
| Professional | 26 | $6.92 | $8.13 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $15.85 / $24.55
| Professional | TC | $11.75 | $15.85 | $24.55 |