- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.72 / $16.98
| Facility | 26 | $2.00 | $3.72 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $18.62 / $32.36
| Professional | | $12.88 | $18.62 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.63 / $7.76
| Professional | 26 | $2.00 | $3.63 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $25.70
| Professional | TC | $10.96 | $14.13 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $13.18
| Professional | | $11.75 | $11.75 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $47.86
| Professional | | $18.20 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $6.46 / $10.72
| Professional | 26 | $3.63 | $6.46 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $19.95 / $34.67
| Professional | TC | $13.18 | $19.95 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $3.16
| Professional | | $2.82 | $2.82 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.65 / $3.02 / $4.37
| Facility | 26 | $0.65 | $3.02 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $23.99 / $45.71
| Professional | | $15.49 | $23.99 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $5.50 / $10.00
| Professional | 26 | $2.88 | $5.50 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $34.67
| Professional | TC | $12.30 | $18.62 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.65 / $3.02 / $4.37
| Facility | 26 | $0.65 | $3.02 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $22.91 / $45.71
| Professional | | $14.79 | $22.91 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $4.90 / $10.23
| Professional | 26 | $2.82 | $4.90 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $34.67
| Professional | TC | $12.30 | $17.78 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $32.36 / $33.11
| Professional | | $13.80 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $35.48
| Professional | | $15.85 | $19.05 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.75 / $3.31 / $6.17
| Professional | 26 | $2.75 | $3.31 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $15.49 / $29.51
| Professional | TC | $13.18 | $15.49 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $23.44 / $38.02
| Professional | | $16.22 | $23.44 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.39 / $5.01 / $8.32
| Professional | 26 | $3.39 | $5.01 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $18.20 / $29.51
| Professional | TC | $12.59 | $18.20 | $29.51 |