- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $8.71 / $9.33
| Facility | 26 | $8.32 | $8.71 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $29.51 / $97.72
| Facility | TC | $15.85 | $29.51 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $57.54
| Professional | | $15.85 | $25.12 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.96 / $28.18
| Professional | 26 | $6.03 | $10.96 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $45.71 / $100.00 / $109.65
| Professional | 50 | $45.71 | $100.00 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $38.02
| Professional | TC | $10.96 | $16.98 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $20.42 / $46.77
| Professional | | $16.22 | $20.42 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $7.24 / $13.18
| Professional | 26 | $6.31 | $7.24 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $64.57 / $64.57
| Professional | | $34.67 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $15.85
| Professional | 26 | $11.75 | $11.75 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $93.33
| Professional | 50 | $69.18 | $69.18 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $30.90
| Professional | TC | $22.91 | $22.91 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $16.98 / $28.84
| Professional | | $8.13 | $16.98 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $28.84 / $57.54
| Professional | | $17.38 | $28.84 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.55 / $19.05
| Professional | 26 | $6.03 | $9.55 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $37.15
| Professional | 50 | $25.70 | $34.67 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $19.95 / $38.02
| Professional | TC | $11.75 | $19.95 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $8.71 / $17.38
| Facility | 26 | $8.32 | $8.71 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $38.02 / $134.90
| Facility | TC | $15.85 | $38.02 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $54.95
| Professional | | $19.05 | $26.30 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.55 / $23.99
| Professional | 26 | $6.03 | $9.55 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $61.66
| Professional | 50 | $45.71 | $45.71 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $36.31
| Professional | TC | $12.88 | $17.78 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $46.77
| Professional | | $17.38 | $24.55 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $8.91 / $14.79
| Professional | 26 | $6.17 | $8.91 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $37.15
| Professional | 50 | $25.70 | $34.67 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $32.36
| Professional | TC | $11.75 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $95.50
| Professional | | $20.42 | $25.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.33 / $87.10
| Professional | 26 | $7.08 | $9.33 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $17.38 / $95.50
| Professional | TC | $12.88 | $17.38 | $95.50 |