- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $19.05 / $23.44
| Facility | 26 | $18.20 | $19.05 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $38.90 / $60.26
| Facility | TC | $38.02 | $38.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $114.82
| Professional | | $39.81 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $45.71
| Professional | 26 | $12.02 | $18.20 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $75.86
| Professional | 50 | $29.51 | $29.51 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $79.43
| Professional | TC | $28.18 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $87.10
| Professional | | $36.31 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $22.91
| Professional | 26 | $11.75 | $13.80 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $52.48 / $67.61
| Professional | | $46.77 | $52.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $16.98 / $21.88
| Professional | 26 | $14.79 | $16.98 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $36.31 / $45.71
| Professional | TC | $31.62 | $36.31 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $45.71 / $81.28
| Professional | | $15.49 | $45.71 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.47 / $15.85 / $22.91
| Facility | 26 | $3.47 | $15.85 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $43.65 / $61.66
| Facility | TC | $9.33 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $97.72
| Professional | | $43.65 | $60.26 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $18.62 / $28.84
| Professional | 26 | $12.59 | $18.62 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $69.18
| Professional | TC | $29.51 | $40.74 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $104.71
| Professional | | $60.26 | $95.50 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $30.20
| Professional | 26 | $22.39 | $26.92 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $74.13
| Professional | TC | $41.69 | $50.12 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $54.95 / $104.71
| Professional | | $45.71 | $54.95 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $16.98 / $30.20
| Professional | 26 | $13.18 | $16.98 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $70.79
| Professional | TC | $30.90 | $37.15 | $70.79 |