- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $97.72
| Facility | 26 | $22.91 | $32.36 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $44.67
| Professional | | $15.14 | $19.05 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $14.79 / $26.30
| Professional | 26 | $7.94 | $14.79 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $19.95
| Professional | TC | $6.03 | $8.91 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $22.39 / $23.99
| Professional | 26 | $19.95 | $22.39 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $34.67
| Professional | | $31.62 | $33.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $18.20 / $19.50
| Professional | 26 | $17.38 | $18.20 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $15.14 / $15.85
| Professional | TC | $14.45 | $15.14 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Facility | 26 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $42.66 / $56.23
| Professional | | $15.14 | $42.66 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $21.38 / $28.84
| Professional | 26 | $11.48 | $21.38 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.51 / $19.50 / $30.90
| Professional | TC | $8.51 | $19.50 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $34.67 / $208.93
| Professional | | $21.38 | $34.67 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $104.71
| Professional | 26 | $12.02 | $19.05 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.12 / $15.85 / $128.82
| Professional | TC | $9.12 | $15.85 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $40.74 / $64.57
| Professional | | $19.05 | $40.74 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $21.38 / $33.88
| Professional | 26 | $19.05 | $21.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $30.90
| Professional | TC | $15.85 | $19.05 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Facility | 26 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $45.71 / $64.57
| Professional | | $38.02 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $19.95 / $33.88
| Professional | 26 | $19.50 | $19.95 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $30.90 / $38.02
| Professional | TC | $16.60 | $30.90 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $17.78 / $33.88
| Professional | | $9.55 | $17.78 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.88 / $44.67
| Professional | | $21.38 | $33.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $18.20 / $26.92
| Professional | 26 | $11.22 | $18.20 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.12 / $15.14 / $21.38
| Professional | TC | $9.12 | $15.14 | $21.38 |