- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $4.79 / $6.76
| Facility | 26 | $2.82 | $4.79 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $165.96
| Professional | | $21.88 | $37.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $3.98 / $11.48
| Professional | 26 | $2.82 | $3.98 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $11.48
| Professional | 52 | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $63.10
| Professional | TC | $19.05 | $25.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $53.70
| Professional | | $22.91 | $32.36 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.95 / $4.17 / $6.17
| Professional | 26 | $2.95 | $4.17 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $48.98
| Professional | TC | $19.95 | $28.18 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $23.44 / $354.81
| Professional | | $3.16 | $23.44 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $3.39 / $4.79
| Professional | 26 | $2.82 | $3.39 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $28.84
| Professional | TC | $20.42 | $20.42 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.74 / $3.47 / $4.90
| Facility | 26 | $0.74 | $3.47 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $40.74 / $141.25
| Professional | | $23.99 | $40.74 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $4.57 / $7.24
| Professional | 26 | $3.16 | $4.57 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $134.90
| Professional | TC | $20.89 | $34.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $35.48
| Professional | | $21.88 | $27.54 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $3.63 / $4.90
| Professional | 26 | $2.88 | $3.63 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $30.90
| Professional | TC | $19.05 | $23.99 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $169.82
| Professional | | $128.82 | $162.18 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $5.75 / $6.31
| Professional | 26 | $5.01 | $5.75 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $32.36 / $147.91
| Professional | | $4.37 | $32.36 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $4.68 / $6.76
| Professional | 26 | $3.24 | $4.68 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $102.33
| Professional | TC | $22.91 | $31.62 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $151.36
| Professional | | $22.39 | $39.81 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $4.07 / $6.61
| Professional | 26 | $2.82 | $4.07 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $33.88 / $141.25
| Professional | TC | $19.50 | $33.88 | $141.25 |