- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.80 / $38.90
| Facility | 26 | $9.77 | $13.80 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $218.78
| Professional | | $36.31 | $66.07 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 25 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.22 / $43.65
| Professional | 26 | $9.55 | $16.22 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $72.44
| Professional | TC | $25.70 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $51.29
| Professional | | $29.51 | $37.15 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $11.48 / $13.18
| Professional | 26 | $9.12 | $11.48 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $38.02
| Professional | TC | $27.54 | $27.54 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $107.15
| Professional | | $47.86 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $30.20
| Professional | 26 | $12.30 | $17.78 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $79.43
| Professional | TC | $34.67 | $47.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $45.71 / $81.28
| Professional | | $35.48 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.30 / $20.42
| Professional | 26 | $9.55 | $12.30 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $61.66
| Professional | TC | $25.70 | $33.11 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $33.88 / $61.66
| Professional | | $11.22 | $33.88 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.45 / $11.48 / $16.60
| Facility | 26 | $2.45 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $114.82
| Professional | | $39.81 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $27.54
| Professional | 26 | $10.47 | $15.14 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $85.11
| Professional | TC | $29.51 | $46.77 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.45 / $11.48 / $16.60
| Facility | 26 | $2.45 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $104.71
| Professional | | $32.36 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $14.13 / $28.18
| Professional | 26 | $9.77 | $14.13 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $83.18
| Professional | TC | $28.84 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $32.36 / $33.11
| Professional | | $10.00 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 26 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $93.33
| Professional | | $42.66 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $13.18 / $23.44
| Professional | 26 | $10.72 | $13.18 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $38.90 / $70.79
| Professional | TC | $31.62 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $60.26 / $100.00
| Professional | | $42.66 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.13 / $25.12
| Professional | 26 | $10.23 | $14.13 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $77.62
| Professional | TC | $33.11 | $46.77 | $77.62 |