- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $19.05 / $36.31
| Facility | 26 | $12.88 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $61.66 / $147.91
| Professional | | $38.02 | $61.66 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $21.88 / $46.77
| Professional | 26 | $12.88 | $21.88 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $74.13
| Professional | TC | $25.70 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $22.39
| Professional | 26 | $8.71 | $8.71 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $107.15
| Professional | | $28.18 | $37.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.47 / $32.36
| Professional | 26 | $8.32 | $10.47 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $69.18
| Professional | TC | $20.42 | $25.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $47.86 / $69.18
| Professional | | $21.88 | $47.86 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $17.38 / $25.12
| Facility | 26 | $3.80 | $17.38 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $223.87
| Professional | | $39.81 | $64.57 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $22.39 / $53.70
| Professional | 26 | $12.02 | $22.39 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $158.49
| Professional | TC | $26.92 | $46.77 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $104.71
| Professional | | $51.29 | $67.61 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $22.39 / $42.66
| Professional | 26 | $15.14 | $22.39 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $72.44
| Professional | TC | $37.15 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $64.57 / $117.49
| Professional | | $32.36 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $20.42 / $36.31
| Professional | 26 | $12.30 | $20.42 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $81.28
| Professional | TC | $23.99 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $50.12 / $67.61
| Professional | | $48.98 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $26.30
| Professional | 26 | $18.20 | $18.20 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $66.07 / $131.83
| Professional | | $54.95 | $66.07 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $21.38 / $39.81
| Professional | 26 | $17.78 | $21.38 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $91.20
| Professional | TC | $37.15 | $43.65 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $190.55
| Professional | | $42.66 | $67.61 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.95 / $91.20
| Professional | 26 | $13.18 | $19.95 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $134.90
| Professional | TC | $29.51 | $46.77 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $50.12
| Facility | 26 | $12.30 | $17.78 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $64.57 / $123.03
| Professional | | $32.36 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $20.42 / $43.65
| Professional | 26 | $12.30 | $20.42 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $87.10
| Professional | TC | $23.99 | $44.67 | $87.10 |