- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.22
| Facility | 26 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $72.44
| Professional | | $22.91 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.96 / $25.70
| Professional | 26 | $6.03 | $10.96 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $24.55 / $51.29
| Professional | TC | $15.85 | $24.55 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.50 / $22.91
| Professional | | $19.05 | $19.50 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Professional | 26 | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $45.71
| Professional | | $25.12 | $36.31 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.22 / $14.45
| Professional | 26 | $7.94 | $11.22 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $31.62
| Professional | TC | $17.38 | $24.55 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $9.55
| Facility | 26 | $9.33 | $9.33 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $69.18
| Professional | | $22.39 | $35.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $21.38
| Professional | 26 | $7.08 | $10.96 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $58.88
| Professional | TC | $17.78 | $25.70 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $58.88
| Professional | | $22.91 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.71 / $52.48
| Professional | 26 | $6.76 | $8.71 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $21.38 / $30.20
| Professional | TC | $16.22 | $21.38 | $30.20 |