- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $28.18 / $112.20
| Facility | 26 | $21.88 | $28.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $186.21
| Professional | | $45.71 | $70.79 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $54.95 / $95.50
| Professional | 26 | $25.12 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $154.88
| Professional | 52 | $22.91 | $43.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $97.72
| Professional | TC | $19.95 | $30.90 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $70.79 / $181.97
| Facility | 26 | $31.62 | $70.79 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $331.13
| Professional | | $47.86 | $72.44 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $181.97
| Professional | 26 | $25.70 | $38.02 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $34.67 / $151.36
| Professional | TC | $22.39 | $34.67 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $151.36
| Professional | | $67.61 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $74.13
| Professional | 26 | $32.36 | $56.23 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $33.11 / $67.61
| Professional | 52 | $16.22 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $79.43 / $154.88
| Professional | | $43.65 | $79.43 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $81.28
| Professional | 26 | $22.91 | $41.69 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $37.15 / $70.79
| Professional | TC | $19.50 | $37.15 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $85.11
| Professional | | $30.20 | $44.67 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $75.86
| Professional | | $26.92 | $37.15 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $53.70
| Professional | 26 | $15.85 | $25.12 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $18.20 / $42.66
| Professional | TC | $12.30 | $18.20 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $125.89
| Professional | | $32.36 | $58.88 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $70.79 / $181.97
| Facility | 26 | $31.62 | $70.79 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $331.13
| Professional | | $47.86 | $72.44 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $181.97
| Professional | 26 | $25.70 | $38.02 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $34.67 / $151.36
| Professional | TC | $22.39 | $34.67 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $102.33
| Professional | | $39.81 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $69.18 / $165.96
| Professional | | $38.02 | $69.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $95.50
| Professional | 26 | $23.99 | $38.02 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $85.11
| Professional | TC | $19.05 | $32.36 | $85.11 |