- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $21.88 / $21.88
| Facility | 26 | $8.91 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $33.88 / $114.82
| Professional | | $14.45 | $33.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.13 / $36.31
| Professional | 26 | $7.08 | $14.13 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $141.25 / $165.96
| Professional | 50 | $131.83 | $141.25 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $22.91 / $75.86
| Professional | TC | $17.38 | $22.91 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $60.26
| Professional | | $26.30 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.72 / $16.98
| Professional | 26 | $8.13 | $10.72 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $42.66
| Professional | TC | $18.20 | $24.55 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $33.11 / $60.26
| Professional | | $13.80 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 26 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $60.26
| Professional | | $39.81 | $47.86 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.59 / $18.20
| Professional | 26 | $10.72 | $12.59 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $42.66
| Professional | TC | $29.51 | $34.67 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $43.65 / $56.23
| Professional | | $26.92 | $43.65 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.30 / $18.20
| Professional | 26 | $7.59 | $12.30 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $38.90
| Professional | TC | $19.50 | $31.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $28.84 / $53.70
| Professional | | $10.96 | $28.84 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $48.98
| Professional | | $25.12 | $28.18 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.32 / $13.80
| Professional | 26 | $6.76 | $8.32 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $20.42 / $34.67
| Professional | TC | $17.78 | $20.42 | $34.67 |