- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $20.89 / $20.89
| Facility | 26 | $18.20 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $58.88 / $371.54
| Professional | | $22.91 | $58.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $89.13
| Professional | 26 | $8.91 | $14.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $24.55 / $120.23
| Professional | TC | $12.88 | $24.55 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $134.90
| Professional | | $22.91 | $43.65 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.45 / $51.29
| Professional | 26 | $9.12 | $14.45 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $25.12 / $81.28
| Professional | TC | $13.80 | $25.12 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.50 / $31.62
| Professional | | $12.02 | $19.50 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $28.18 / $45.71
| Facility | 26 | $24.55 | $28.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $74.13 / $102.33
| Professional | | $24.55 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $23.99 / $38.02
| Professional | 26 | $10.96 | $23.99 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $52.48 / $63.10
| Professional | TC | $19.95 | $52.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $56.23 / $75.86
| Professional | | $46.77 | $56.23 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $20.89 / $28.18
| Professional | 26 | $17.38 | $20.89 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $33.88 / $47.86
| Professional | TC | $29.51 | $33.88 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Facility | 53 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $75.86 / $758.58
| Professional | | $26.92 | $75.86 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $23.44 / $131.83
| Professional | 26 | $10.72 | $23.44 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $42.66 / $707.95
| Professional | TC | $14.79 | $42.66 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $77.62 / $162.18
| Professional | | $30.90 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $21.88 / $35.48
| Professional | 26 | $13.18 | $21.88 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $45.71 / $138.04
| Professional | TC | $20.42 | $45.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $269.15
| Professional | | $33.88 | $64.57 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $131.83 / $131.83
| Facility | 26 | $21.88 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $11.75 / $67.61 / $67.61
| Facility | 53 | $11.75 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $457.09 / $758.58
| Professional | | $23.44 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $48.98 / $131.83
| Professional | 26 | $13.49 | $48.98 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $416.87 / $707.95
| Professional | TC | $23.44 | $416.87 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | 26 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Professional | TC | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $154.88 / $389.05
| Professional | | $50.12 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $177.83
| Professional | 26 | $21.88 | $27.54 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $245.47
| Professional | TC | $28.84 | $36.31 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $169.82
| Professional | | $46.77 | $95.50 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $61.66 / $95.50
| Professional | 26 | $18.62 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $30.20 / $144.54
| Professional | TC | $13.49 | $30.20 | $144.54 |