- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $17.78 / $31.62
| Facility | 26 | $14.13 | $17.78 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $208.93
| Professional | | $34.67 | $56.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.60 / $47.86
| Professional | 26 | $10.00 | $16.60 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $104.71
| Professional | TC | $25.12 | $38.02 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $91.20 / $125.89
| Professional | | $44.67 | $91.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $23.44
| Professional | 26 | $9.55 | $9.55 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | TC | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $141.25
| Professional | | $66.07 | $97.72 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $37.15
| Professional | 26 | $17.38 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $104.71
| Professional | TC | $48.98 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $72.44 / $144.54
| Professional | | $40.74 | $72.44 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $21.38 / $37.15
| Professional | 26 | $11.48 | $21.38 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $52.48 / $107.15
| Professional | TC | $27.54 | $52.48 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $24.55 / $165.96
| Facility | 26 | $14.13 | $24.55 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $79.43 / $123.03
| Professional | | $44.67 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $22.91 / $31.62
| Professional | 26 | $12.59 | $22.91 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $56.23 / $93.33
| Professional | TC | $30.20 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $33.11
| Professional | | $22.91 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $97.72
| Professional | | $17.38 | $34.67 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.98
| Facility | 26 | $16.60 | $16.60 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $134.90
| Professional | | $64.57 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $36.31
| Professional | 26 | $16.98 | $26.30 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $100.00
| Professional | TC | $47.86 | $72.44 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $93.33 / $134.90
| Professional | | $66.07 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $35.48
| Professional | 26 | $16.98 | $26.30 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $100.00
| Professional | TC | $48.98 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $123.03
| Professional | | $41.69 | $53.70 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.49 / $36.31
| Professional | 26 | $12.59 | $15.49 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $89.13
| Professional | TC | $28.18 | $38.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $104.71
| Professional | | $56.23 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $14.45 / $25.70
| Professional | 26 | $13.49 | $14.45 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $79.43
| Professional | TC | $41.69 | $41.69 | $79.43 |