- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $16.98
| Facility | 26 | $8.91 | $8.91 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $83.18
| Professional | | $33.11 | $40.74 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $21.88
| Professional | 26 | $7.94 | $10.00 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $50.12
| Professional | TC | $22.91 | $28.18 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | 26 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $67.61
| Professional | | $28.84 | $47.86 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $21.88
| Professional | 26 | $8.91 | $15.14 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $33.88 / $47.86
| Professional | TC | $20.42 | $33.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $33.11
| Professional | | $22.91 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $72.44
| Professional | | $28.84 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $11.75 / $22.39
| Professional | 26 | $9.12 | $11.75 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $50.12
| Professional | TC | $19.95 | $28.84 | $50.12 |