- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $64.57
| Facility | 26 | $19.95 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $177.83
| Professional | | $48.98 | $70.79 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $57.54
| Professional | 26 | $16.98 | $23.44 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $89.13
| Professional | TC | $32.36 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $57.54
| Professional | 26 | $19.50 | $20.42 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $128.82 / $181.97
| Professional | | $51.29 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $44.67 / $63.10
| Professional | 26 | $17.38 | $44.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $85.11 / $120.23
| Professional | TC | $33.88 | $85.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $162.18
| Professional | | $56.23 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $50.12
| Professional | 26 | $18.62 | $31.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $67.61 / $117.49
| Professional | TC | $38.02 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $138.04
| Professional | | $58.88 | $93.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $47.86
| Professional | 26 | $20.42 | $31.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $95.50
| Professional | TC | $39.81 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $165.96
| Professional | | $58.88 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $56.23
| Professional | 26 | $19.05 | $30.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $114.82
| Professional | TC | $37.15 | $69.18 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $18.62
| Facility | 26 | $12.02 | $16.98 | $18.62 |