- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $6.76 / $11.75
| Facility | 26 | $6.46 | $6.76 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $257.04
| Facility | TC | $26.92 | $38.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $45.71 / $131.83
| Professional | | $15.14 | $45.71 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.72 / $30.90
| Professional | 26 | $6.03 | $10.72 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $48.98 / $97.72 / $162.18
| Professional | 50 | $48.98 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.47 / $33.88 / $158.49
| Professional | 52 | $10.47 | $33.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $33.88 / $66.07
| Professional | TC | $22.39 | $33.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $47.86
| Professional | | $25.12 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $6.31 / $8.13
| Professional | 26 | $5.13 | $6.31 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | 50 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $38.02
| Professional | TC | $27.54 | $33.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $46.77
| Professional | | $22.91 | $26.92 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $6.92 / $12.30
| Professional | 26 | $5.50 | $6.92 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $69.18
| Professional | 50 | $34.67 | $40.74 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $21.38 / $33.11
| Professional | TC | $16.60 | $21.38 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $29.51 / $44.67
| Professional | | $6.76 | $29.51 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.62 / $7.59 / $10.96
| Facility | 26 | $1.62 | $7.59 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.41 / $34.67 / $48.98
| Facility | TC | $7.41 | $34.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $177.83
| Professional | | $25.70 | $43.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $10.47 / $33.88
| Professional | 26 | $5.89 | $10.47 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $147.91
| Professional | TC | $19.05 | $36.31 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $32.36 / $33.11
| Professional | | $11.48 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $57.54
| Professional | | $21.88 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $7.24 / $12.88
| Professional | 26 | $5.75 | $7.24 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $24.55 / $45.71
| Professional | TC | $15.14 | $24.55 | $45.71 |