- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $7.94 / $9.33
| Facility | 26 | $6.61 | $7.94 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $38.02 / $109.65
| Professional | | $15.85 | $38.02 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $13.80 / $36.31
| Professional | 26 | $6.61 | $13.80 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.90 / $81.28 / $114.82
| Professional | 50 | $38.90 | $81.28 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $28.84
| Professional | 52 | $21.88 | $27.54 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $57.54
| Professional | TC | $16.60 | $28.84 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $28.84 / $32.36
| Professional | | $8.13 | $28.84 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $7.41 / $8.51
| Professional | 26 | $7.24 | $7.41 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $26.92
| Professional | TC | $20.89 | $23.99 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | 26 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $57.54
| Professional | | $22.39 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $8.71 / $16.22
| Professional | 26 | $5.89 | $8.71 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $22.91 / $42.66
| Professional | TC | $16.22 | $22.91 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $33.11 / $45.71
| Professional | | $30.20 | $33.11 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.71 / $12.02
| Professional | 26 | $7.94 | $8.71 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $24.55 / $33.88
| Professional | TC | $21.88 | $24.55 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $63.10
| Professional | | $21.88 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $8.71 / $16.98
| Professional | 26 | $6.17 | $8.71 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $22.39 / $45.71
| Professional | TC | $15.49 | $22.39 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $46.77
| Professional | | $21.38 | $33.11 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $8.32 / $11.75
| Professional | 26 | $5.62 | $8.32 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $24.55 / $35.48
| Professional | TC | $15.85 | $24.55 | $35.48 |