- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.98 / $4.90 / $12.59
| Facility | 26 | $3.98 | $4.90 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $22.91 / $39.81
| Professional | | $12.88 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $13.18
| Professional | 26 | $2.00 | $3.98 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $18.20 / $28.18
| Professional | TC | $10.96 | $18.20 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- 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
- $3.98 / $5.75 / $9.33
| Professional | 26 | $3.98 | $5.75 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $23.99 / $37.15
| Professional | TC | $16.60 | $23.99 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.65 / $3.02 / $4.37
| Facility | 26 | $0.65 | $3.02 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $32.36 / $53.70
| Professional | | $17.38 | $32.36 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.31 / $6.46 / $10.72
| Professional | 26 | $3.31 | $6.46 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $25.70 / $44.67
| Professional | TC | $14.13 | $25.70 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $6.46 / $13.49
| Facility | 26 | $4.37 | $6.46 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $53.70
| Professional | | $19.50 | $31.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $6.03 / $10.96
| Professional | 26 | $3.80 | $6.03 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $42.66
| Professional | TC | $15.85 | $25.12 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $32.36 / $33.11
| Professional | | $2.09 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $12.02 / $42.66
| Professional | | $4.90 | $12.02 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $4.07 / $4.07
| Facility | 26 | $3.63 | $4.07 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $43.65
| Professional | | $20.42 | $28.84 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $5.25 / $7.94
| Professional | 26 | $3.63 | $5.25 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $36.31
| Professional | TC | $16.98 | $23.99 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- 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
- $3.98 / $5.37 / $9.33
| Professional | 26 | $3.98 | $5.37 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $37.15
| Professional | TC | $16.60 | $23.44 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $46.77
| Professional | | $19.50 | $31.62 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $7.08 / $9.77
| Professional | 26 | $3.80 | $7.08 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $38.02
| Professional | TC | $15.85 | $25.12 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $19.50 / $37.15
| Professional | | $16.98 | $19.50 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $3.02 / $5.37
| Professional | 26 | $2.63 | $3.02 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $16.60 / $31.62
| Professional | TC | $14.45 | $16.60 | $31.62 |