- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.60 / $31.62
| Facility | 26 | $9.55 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $131.83
| Professional | | $30.90 | $48.98 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $16.22 / $37.15
| Professional | 26 | $9.77 | $16.22 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $70.79
| Professional | TC | $21.88 | $32.36 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $64.57
| Professional | | $35.48 | $35.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $93.33
| Professional | | $29.51 | $38.02 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.59 / $24.55
| Professional | 26 | $10.00 | $12.59 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $24.55 / $61.66
| Professional | TC | $19.95 | $24.55 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $43.65 / $61.66
| Professional | | $16.98 | $43.65 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.95 / $13.80 / $19.50
| Facility | 26 | $2.95 | $13.80 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $154.88
| Professional | | $34.67 | $57.54 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $17.38 / $41.69
| Professional | 26 | $9.33 | $17.38 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $41.69 / $147.91
| Professional | TC | $24.55 | $41.69 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $91.20
| Professional | | $44.67 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $34.67
| Professional | 26 | $11.75 | $17.38 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $66.07
| Professional | TC | $33.88 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $56.23 / $102.33
| Professional | | $26.92 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $15.85 / $28.18
| Professional | 26 | $9.77 | $15.85 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $74.13
| Professional | TC | $19.95 | $40.74 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $104.71
| Professional | | $43.65 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.45 / $19.95
| Professional | 26 | $14.13 | $14.45 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $57.54 / $114.82
| Professional | | $48.98 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $17.38 / $31.62
| Professional | 26 | $14.45 | $17.38 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $83.18
| Professional | TC | $33.88 | $39.81 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $169.82
| Professional | | $37.15 | $57.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $15.49 / $70.79
| Professional | 26 | $10.23 | $15.49 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $125.89
| Professional | TC | $26.30 | $42.66 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.80 / $39.81
| Facility | 26 | $9.77 | $13.80 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $56.23 / $109.65
| Professional | | $30.20 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $15.85 / $33.88
| Professional | 26 | $9.77 | $15.85 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $79.43
| Professional | TC | $19.95 | $40.74 | $79.43 |