- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $36.31
| Facility | 26 | $10.72 | $14.79 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $371.54
| Professional | | $30.20 | $45.71 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.00 / $26.30
| Professional | 26 | $7.59 | $10.00 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $125.89
| Professional | TC | $21.88 | $33.88 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $128.82
| Professional | | $32.36 | $40.74 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $11.75 / $30.90
| Professional | 26 | $7.59 | $11.75 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $97.72
| Professional | | $39.81 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $14.45 / $20.89
| Professional | 26 | $9.33 | $14.45 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $46.77 / $66.07
| Professional | TC | $30.20 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $81.28 / $199.53
| Professional | | $47.86 | $81.28 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $15.85 / $27.54
| Professional | 26 | $10.47 | $15.85 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $67.61 / $154.88
| Professional | TC | $34.67 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $109.65
| Professional | | $46.77 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $16.98 / $25.12
| Professional | 26 | $10.72 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $83.18
| Professional | TC | $35.48 | $53.70 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $141.25
| Professional | | $46.77 | $70.79 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.45 / $28.84
| Professional | 26 | $10.23 | $14.45 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $104.71
| Professional | TC | $34.67 | $50.12 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $7.59 / $9.33
| Facility | 26 | $6.92 | $7.59 | $9.33 |