- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $16.98
| Facility | 26 | $14.13 | $14.13 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $199.53 / $501.19
| Facility | TC | $47.86 | $199.53 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $138.04
| Professional | | $44.67 | $60.26 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.22 / $35.48
| Professional | 26 | $12.02 | $16.22 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $100.00
| Professional | TC | $30.90 | $41.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $83.18
| Professional | | $35.48 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $11.22 / $21.38
| Professional | 26 | $10.72 | $11.22 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | TC | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $51.29 / $85.11
| Professional | | $48.98 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $13.49 / $22.91
| Professional | 26 | $13.18 | $13.49 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $87.10
| Professional | 50 | $63.10 | $74.13 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $61.66
| Professional | TC | $33.88 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $91.20
| Professional | | $38.90 | $60.26 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $17.78 / $25.12
| Professional | 26 | $12.02 | $17.78 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $67.61
| Professional | TC | $28.84 | $44.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $64.57 / $87.10
| Professional | | $0.32 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.09 / $16.60 / $22.39
| Professional | 26 | $0.09 | $16.60 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.23 / $48.98 / $64.57
| Professional | TC | $0.23 | $48.98 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.32 / $81.28
| Professional | | $0.32 | $0.32 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $20.89
| Professional | 26 | $0.09 | $0.09 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $60.26
| Professional | TC | $0.23 | $0.23 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $53.70 / $54.95
| Professional | | $51.29 | $53.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $13.80 / $14.13
| Professional | 26 | $13.49 | $13.80 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $40.74
| Professional | TC | $38.02 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $87.10
| Professional | | $38.90 | $52.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $15.14 / $27.54
| Professional | 26 | $12.30 | $15.14 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $61.66
| Professional | TC | $26.92 | $37.15 | $61.66 |