- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $21.88 / $53.70
| Facility | 26 | $12.02 | $21.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $91.20
| Professional | | $34.67 | $47.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $30.90
| Professional | 26 | $10.00 | $12.88 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $63.10
| Professional | TC | $23.99 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $95.50
| Professional | | $43.65 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $16.98 / $26.30
| Professional | 26 | $12.59 | $16.98 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $67.61
| Professional | TC | $30.90 | $43.65 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $48.98 / $134.90
| Professional | | $12.88 | $48.98 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $14.13 / $17.78
| Professional | 26 | $13.49 | $14.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $50.12
| Professional | TC | $33.88 | $39.81 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | 26 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $95.50
| Professional | | $37.15 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $16.22 / $28.84
| Professional | 26 | $10.47 | $16.22 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $72.44
| Professional | TC | $26.30 | $37.15 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $54.95 / $70.79
| Professional | | $45.71 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $19.05
| Professional | 26 | $12.02 | $14.79 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $52.48
| Professional | TC | $33.11 | $40.74 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $104.71
| Professional | | $57.54 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $29.51
| Professional | 26 | $19.50 | $23.99 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $79.43
| Professional | | $64.57 | $64.57 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $50.12 / $123.03
| Professional | | $17.38 | $50.12 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $18.20 / $30.20
| Professional | 26 | $13.80 | $18.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $75.86
| Professional | TC | $32.36 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $95.50
| Professional | | $33.88 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $15.85 / $28.84
| Professional | 26 | $10.47 | $15.85 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $66.07
| Professional | TC | $23.44 | $36.31 | $66.07 |