- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $19.05 / $58.88
| Facility | 26 | $7.94 | $19.05 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $61.66 / $169.82
| Facility | TC | $22.91 | $61.66 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $81.28
| Professional | | $19.05 | $30.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.30 / $23.99
| Professional | 26 | $7.08 | $12.30 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $47.86
| Professional | TC | $15.85 | $22.91 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $141.25
| Professional | | $29.51 | $38.02 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $9.55 / $9.55
| Professional | 26 | $8.51 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $28.18
| Professional | TC | $25.12 | $25.12 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $81.28
| Professional | | $26.30 | $35.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.96 / $23.44
| Professional | 26 | $7.59 | $10.96 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $24.55 / $60.26
| Professional | TC | $18.62 | $24.55 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $77.62
| Professional | | $33.11 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.77 / $19.95
| Professional | 26 | $8.32 | $9.77 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $57.54
| Professional | TC | $24.55 | $28.84 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $95.50 / $177.83
| Professional | | $26.92 | $95.50 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $54.95 / $95.50
| Professional | 26 | $8.71 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $32.36 / $107.15
| Professional | TC | $17.38 | $32.36 | $107.15 |