- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $6.61 / $13.49
| Facility | 26 | $5.01 | $6.61 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $112.20 / $331.13
| Facility | TC | $29.51 | $112.20 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $43.65 / $158.49
| Professional | | $12.30 | $43.65 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $11.75 / $40.74
| Professional | 26 | $6.03 | $11.75 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $15.85 / $75.86 / $154.88
| Professional | 50 | $15.85 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.47 / $72.44 / $141.25
| Professional | 52 | $10.47 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $97.72
| Professional | TC | $22.91 | $38.02 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | 26 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | TC | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $91.20 / $114.82
| Professional | | $29.51 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $15.14 / $19.05
| Professional | 26 | $6.76 | $15.14 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $75.86 / $95.50
| Professional | TC | $22.91 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $134.90
| Professional | | $33.88 | $56.23 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $11.22 / $26.92
| Professional | 26 | $6.17 | $11.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $107.15
| Professional | TC | $26.92 | $42.66 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $100.00 / $100.00
| Facility | 26 | $21.38 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $144.54 / $144.54
| Facility | TC | $83.18 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $56.23 / $239.88
| Professional | | $28.18 | $56.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $11.22 / $51.29
| Professional | 26 | $6.92 | $11.22 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $199.53
| Professional | TC | $20.89 | $36.31 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $95.50
| Professional | | $51.29 | $81.28 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $16.22 / $16.98
| Professional | 26 | $13.18 | $16.22 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $77.62
| Professional | TC | $38.02 | $60.26 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | 26 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | TC | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $89.13 / $95.50
| Professional | | $69.18 | $89.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $16.22 / $19.95
| Professional | 26 | $13.49 | $16.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $77.62
| Professional | TC | $56.23 | $74.13 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $33.88 / $72.44
| Professional | | $7.08 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $50.12 / $97.72
| Professional | | $29.51 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $11.48 / $53.70
| Professional | 26 | $6.92 | $11.48 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $38.90 / $83.18
| Professional | TC | $22.39 | $38.90 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $77.62
| Professional | | $66.07 | $66.07 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $13.49
| Professional | 26 | $11.48 | $11.48 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $63.10
| Professional | TC | $53.70 | $53.70 | $63.10 |