- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $19.50 / $19.50
| Facility | 26 | $18.62 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $53.70 / $154.88
| Professional | | $39.81 | $53.70 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.88 / $33.88
| Professional | 26 | $8.91 | $12.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $70.79
| Professional | TC | $30.20 | $39.81 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $40.74 / $89.13
| Professional | | $9.33 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $93.33
| Professional | | $44.67 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $17.78 / $26.30
| Professional | 26 | $11.22 | $17.78 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $74.13
| Professional | TC | $33.88 | $46.77 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $58.88
| Professional | | $32.36 | $33.11 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $131.83
| Professional | | $51.29 | $77.62 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $18.20 / $26.30
| Professional | 26 | $11.22 | $18.20 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $74.13
| Professional | TC | $34.67 | $47.86 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $114.82
| Professional | | $48.98 | $56.23 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $15.49 / $32.36
| Professional | 26 | $13.80 | $15.49 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $85.11
| Professional | TC | $35.48 | $42.66 | $85.11 |