- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $46.77 / $54.95
| Facility | 26 | $15.14 | $46.77 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $151.36
| Professional | | $38.02 | $53.70 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.88 / $37.15
| Professional | 26 | $8.91 | $12.88 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $39.81 / $97.72
| Professional | TC | $27.54 | $39.81 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $112.20
| Professional | | $40.74 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $25.70
| Professional | 26 | $10.72 | $14.79 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $50.12 / $87.10
| Professional | TC | $30.20 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $77.62 / $131.83
| Professional | | $48.98 | $77.62 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $26.92
| Professional | 26 | $12.88 | $16.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $58.88 / $123.03
| Professional | TC | $36.31 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $83.18
| Professional | | $47.86 | $58.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $15.49 / $18.62
| Professional | 26 | $13.18 | $15.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $72.44
| Professional | TC | $42.66 | $57.54 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $21.38 / $83.18
| Professional | | $16.60 | $21.38 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $69.18 / $147.91
| Professional | | $44.67 | $69.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $14.79 / $33.11
| Professional | 26 | $10.00 | $14.79 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $95.50
| Professional | TC | $33.88 | $53.70 | $95.50 |