- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.39 / $4.57 / $5.89
| Facility | 26 | $3.39 | $4.57 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $42.66 / $144.54
| Professional | | $22.91 | $42.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $5.13 / $15.14
| Professional | 26 | $2.88 | $5.13 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $5.25 / $5.75 / $5.75
| Professional | 52 | $5.25 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $97.72
| Professional | TC | $19.05 | $28.84 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $21.88 / $30.90
| Professional | | $17.38 | $21.88 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $3.31 / $4.57
| Professional | 26 | $2.29 | $3.31 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $95.50 / $158.49
| Professional | | $30.90 | $95.50 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.47 / $4.68 / $7.59
| Professional | 26 | $3.47 | $4.68 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $89.13 / $147.91
| Professional | TC | $26.92 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $39.81
| Professional | | $28.18 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.27 / $5.89 / $5.89
| Professional | 26 | $4.27 | $5.89 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $33.88
| Professional | TC | $23.99 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $19.50 / $31.62
| Professional | | $3.02 | $19.50 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $114.82
| Professional | | $22.91 | $36.31 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $4.47 / $7.08
| Professional | 26 | $3.09 | $4.47 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $107.15
| Professional | TC | $19.95 | $31.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $112.20
| Professional | | $20.89 | $33.88 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $4.68 / $7.41
| Professional | 26 | $3.16 | $4.68 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $95.50
| Professional | TC | $19.50 | $29.51 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $32.36 / $33.11
| Professional | | $3.98 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $51.29
| Professional | | $22.91 | $27.54 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.39 / $3.98 / $7.59
| Professional | 26 | $3.39 | $3.98 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $43.65
| Professional | TC | $19.50 | $23.44 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $102.33
| Professional | | $21.38 | $30.90 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.69 / $3.98 / $6.76
| Professional | 26 | $2.69 | $3.98 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $26.30 / $89.13
| Professional | TC | $17.78 | $26.30 | $89.13 |