- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $25.12 / $60.26
| Facility | 26 | $15.14 | $25.12 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $72.44 / $323.59
| Facility | TC | $38.90 | $72.44 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $181.97
| Professional | | $36.31 | $50.12 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $79.43
| Professional | 26 | $12.02 | $18.20 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $79.43
| Professional | TC | $23.44 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | 26 | $24.55 | $24.55 | $24.55 |
- 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
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | TC | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $134.90
| Professional | | $61.66 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $28.84 / $39.81
| Professional | 26 | $18.62 | $28.84 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $66.07 / $93.33
| Professional | TC | $43.65 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $77.62 / $138.04
| Professional | | $40.74 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $24.55 / $39.81
| Professional | 26 | $13.80 | $24.55 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $52.48 / $97.72
| Professional | TC | $26.92 | $52.48 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $275.42
| Facility | 26 | $18.20 | $28.84 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $275.42
| Facility | TC | $33.88 | $58.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $117.49
| Professional | | $44.67 | $85.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $26.92 / $38.02
| Professional | 26 | $16.60 | $26.92 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $56.23 / $83.18
| Professional | TC | $30.20 | $56.23 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $33.11
| Professional | | $20.89 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $37.15 / $60.26
| Professional | | $19.50 | $37.15 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Facility | 26 | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | TC | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $128.82
| Professional | | $61.66 | $91.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $38.90
| Professional | 26 | $18.20 | $28.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $91.20
| Professional | TC | $42.66 | $66.07 | $91.20 |
- 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
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | TC | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $128.82
| Professional | | $61.66 | $93.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $28.84 / $38.90
| Professional | 26 | $18.62 | $28.84 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $89.13
| Professional | TC | $43.65 | $63.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $114.82
| Professional | | $44.67 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $40.74
| Professional | 26 | $13.80 | $18.62 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $77.62
| Professional | TC | $28.18 | $35.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $52.48 / $97.72
| Professional | | $51.29 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $15.14 / $26.92
| Professional | 26 | $14.13 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $70.79
| Professional | TC | $37.15 | $37.15 | $70.79 |