- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $7.76
| Facility | 26 | $6.03 | $6.03 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $151.36 / $316.23
| Facility | TC | $27.54 | $151.36 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $131.83
| Professional | | $19.50 | $38.90 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $8.13 / $27.54
| Professional | 26 | $5.01 | $8.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $79.43
| Professional | TC | $18.20 | $26.92 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.39 / $35.48
| Professional | | $19.05 | $22.39 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.90 / $5.13 / $9.77
| Professional | 26 | $4.90 | $5.13 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $72.44
| Professional | TC | $24.55 | $24.55 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $45.71
| Professional | | $27.54 | $27.54 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $10.23
| Professional | 26 | $6.03 | $6.03 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $21.38 / $36.31
| Professional | TC | $20.89 | $21.38 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $50.12
| Professional | | $23.44 | $33.11 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $8.13 / $10.96
| Professional | 26 | $5.37 | $8.13 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $40.74
| Professional | TC | $18.20 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $34.67 / $45.71
| Professional | | $0.18 | $34.67 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.06 / $7.59 / $10.00
| Professional | 26 | $0.06 | $7.59 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.12 / $26.92 / $35.48
| Professional | TC | $0.12 | $26.92 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $42.66
| Professional | | $0.18 | $0.18 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.06 / $0.06 / $9.33
| Professional | 26 | $0.06 | $0.06 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $33.88
| Professional | TC | $0.12 | $0.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $28.84 / $30.20
| Professional | | $27.54 | $28.84 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $6.31 / $6.46
| Professional | 26 | $6.17 | $6.31 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $22.39 / $23.44
| Professional | TC | $20.89 | $22.39 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $46.77
| Professional | | $20.42 | $29.51 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $6.92 / $12.30
| Professional | 26 | $4.57 | $6.92 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $38.90
| Professional | TC | $15.14 | $21.88 | $38.90 |