- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.32 / $16.22
| Facility | 26 | $7.24 | $8.32 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $79.43 / $467.74
| Facility | TC | $28.18 | $79.43 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $43.65 / $147.91
| Professional | | $20.89 | $43.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $11.22 / $35.48
| Professional | 26 | $5.01 | $11.22 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $91.20
| Professional | TC | $18.20 | $30.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $66.07
| Professional | | $26.92 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.68 / $10.00 / $11.22
| Professional | 26 | $4.68 | $10.00 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $43.65
| Professional | TC | $20.42 | $35.48 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | 26 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | TC | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $87.10
| Professional | | $41.69 | $61.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.49 / $19.05
| Professional | 26 | $8.91 | $13.49 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $69.18
| Professional | TC | $31.62 | $47.86 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $47.86 / $89.13
| Professional | | $25.70 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $10.96 / $19.05
| Professional | 26 | $5.75 | $10.96 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $37.15 / $70.79
| Professional | TC | $19.50 | $37.15 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.59 / $165.96
| Facility | 26 | $7.08 | $12.59 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $44.67 / $165.96
| Facility | TC | $23.44 | $44.67 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $77.62
| Professional | | $29.51 | $53.70 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $11.48 / $16.22
| Professional | 26 | $6.31 | $11.48 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $42.66 / $63.10
| Professional | TC | $22.39 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $32.36 / $33.11
| Professional | | $15.14 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $13.80 / $43.65
| Professional | | $7.59 | $13.80 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $8.71
| Facility | 26 | $8.71 | $8.71 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $31.62
| Facility | TC | $30.90 | $30.90 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $85.11
| Professional | | $39.81 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $13.49 / $18.62
| Professional | 26 | $8.71 | $13.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $66.07
| Professional | TC | $31.62 | $47.86 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | 26 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | TC | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $83.18
| Professional | | $39.81 | $60.26 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $13.49 / $18.20
| Professional | 26 | $8.71 | $13.49 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $66.07
| Professional | TC | $31.62 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $77.62
| Professional | | $26.92 | $33.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $7.94 / $18.62
| Professional | 26 | $6.46 | $7.94 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $60.26
| Professional | TC | $20.42 | $25.70 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $34.67 / $64.57
| Professional | | $33.88 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $7.41 / $13.18
| Professional | 26 | $6.92 | $7.41 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $52.48
| Professional | TC | $26.92 | $27.54 | $52.48 |