- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.91 / $8.91
| Facility | 26 | $6.31 | $8.91 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $251.19
| Facility | TC | $28.84 | $38.02 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $35.48 / $91.20
| Professional | | $13.80 | $35.48 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $13.18 / $28.84
| Professional | 26 | $6.03 | $13.18 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $48.98 / $144.54 / $288.40
| Professional | 50 | $48.98 | $144.54 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.30 / $60.26 / $67.61
| Professional | 52 | $26.30 | $60.26 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $72.44
| Professional | TC | $21.88 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $30.90 / $41.69
| Professional | | $23.44 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $7.59 / $9.77
| Professional | 26 | $5.01 | $7.59 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $43.65
| Professional | TC | $19.05 | $25.12 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $52.48
| Professional | | $28.84 | $40.74 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $9.55 / $12.02
| Professional | 26 | $6.61 | $9.55 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $40.74
| Professional | TC | $21.88 | $31.62 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $7.41
| Facility | 26 | $7.41 | $7.41 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.89
| Facility | TC | $20.42 | $20.42 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $77.62
| Professional | | $22.39 | $37.15 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $8.71 / $16.98
| Professional | 26 | $5.62 | $8.71 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $70.79
| Professional | TC | $18.62 | $30.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $33.88 / $63.10
| Professional | | $22.39 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $6.92 / $13.80
| Professional | 26 | $5.37 | $6.92 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $54.95
| Professional | TC | $16.98 | $26.30 | $54.95 |