- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $38.90 / $45.71
| Facility | 26 | $12.59 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $79.43
| Professional | | $23.99 | $32.36 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.96 / $24.55
| Professional | 26 | $7.41 | $10.96 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $20.89 / $52.48
| Professional | TC | $15.14 | $20.89 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $67.61
| Professional | | $25.70 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.30 / $21.38
| Professional | 26 | $9.33 | $12.30 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $27.54 / $46.77
| Professional | TC | $16.60 | $27.54 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $79.43
| Professional | | $33.88 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $22.91
| Professional | 26 | $10.47 | $14.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $33.88 / $64.57
| Professional | TC | $24.55 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $48.98
| Professional | | $30.20 | $38.90 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $13.18 / $15.85
| Professional | 26 | $10.72 | $13.18 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $38.02
| Professional | TC | $24.55 | $31.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Professional | | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $69.18
| Professional | | $26.92 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.02 / $21.88
| Professional | 26 | $8.32 | $12.02 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $69.18
| Professional | TC | $18.20 | $29.51 | $69.18 |