- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $17.78 / $23.44
| Facility | 26 | $15.49 | $17.78 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $109.65
| Professional | | $34.67 | $43.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $37.15
| Professional | 26 | $10.96 | $15.85 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $51.29
| Professional | TC | $22.91 | $28.18 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $19.50 / $25.70
| Professional | 26 | $10.47 | $19.50 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $44.67 / $74.13
| Professional | | $39.81 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $17.78 / $27.54
| Professional | 26 | $13.80 | $17.78 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $26.92 / $50.12
| Professional | TC | $25.12 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $54.95 / $95.50
| Professional | | $34.67 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $17.78 / $30.20
| Professional | 26 | $11.75 | $17.78 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $64.57
| Professional | TC | $24.55 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $81.28
| Professional | | $35.48 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.14 / $30.20
| Professional | 26 | $12.59 | $15.14 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $50.12
| Professional | TC | $23.44 | $28.84 | $50.12 |