- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $5.37 / $5.37
| Facility | 26 | $5.25 | $5.37 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $47.86 / $114.82
| Professional | | $23.44 | $47.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $5.75 / $15.49
| Professional | 26 | $2.82 | $5.75 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $3.47
| Professional | 52 | $3.47 | $3.47 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $85.11
| Professional | TC | $19.95 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $44.67
| Professional | | $35.48 | $42.66 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.79 / $6.03 / $6.31
| Professional | 26 | $4.79 | $6.03 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $38.90
| Professional | TC | $30.90 | $36.31 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $64.57
| Professional | | $28.18 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $5.13 / $8.32
| Professional | 26 | $3.63 | $5.13 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $60.26
| Professional | TC | $23.44 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $549.54
| Professional | | $77.62 | $77.62 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $61.66
| Professional | 26 | $14.13 | $14.13 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $489.78
| Professional | TC | $63.10 | $63.10 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $5.25 / $6.61
| Facility | 26 | $4.57 | $5.25 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $109.65
| Professional | | $26.30 | $43.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.03 / $10.96
| Professional | 26 | $3.02 | $6.03 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $3.47
| Professional | 52 | $3.47 | $3.47 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $60.26
| Professional | TC | $22.91 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $32.36 / $33.11
| Professional | | $2.45 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $48.98
| Professional | | $29.51 | $34.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $4.47 / $6.31
| Professional | 26 | $3.80 | $4.47 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $42.66
| Professional | TC | $25.70 | $30.20 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $66.07
| Professional | | $21.88 | $21.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $5.37
| Professional | 26 | $3.24 | $3.24 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $33.11
| Professional | TC | $18.62 | $18.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $83.18
| Professional | | $25.12 | $38.02 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.31 / $4.90 / $6.76
| Professional | 26 | $3.31 | $4.90 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $33.11 / $57.54
| Professional | TC | $21.88 | $33.11 | $57.54 |