- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $13.49 / $13.49
| Facility | 26 | $12.88 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $72.44
| Professional | | $20.89 | $30.20 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.33 / $23.99
| Professional | 26 | $6.03 | $9.33 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $20.89 / $47.86
| Professional | TC | $14.13 | $20.89 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $19.95 / $36.31
| Professional | | $7.59 | $19.95 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $46.77 / $74.13
| Professional | | $25.70 | $46.77 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.18 / $20.89
| Professional | 26 | $7.94 | $13.18 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $32.36 / $52.48
| Professional | TC | $17.78 | $32.36 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $32.36 / $33.11
| Professional | | $16.22 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $52.48 / $74.13
| Professional | | $26.30 | $52.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $13.18 / $20.89
| Professional | 26 | $8.13 | $13.18 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $31.62 / $45.71
| Professional | TC | $17.78 | $31.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $38.02 / $70.79
| Professional | | $31.62 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $11.22 / $26.92
| Professional | 26 | $9.77 | $11.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $26.30 / $44.67
| Professional | TC | $21.88 | $26.30 | $44.67 |