- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $8.91
| Facility | 26 | $7.94 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $69.18
| Professional | | $32.36 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.71 / $25.12
| Professional | 26 | $7.08 | $8.71 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $44.67
| Professional | TC | $25.12 | $28.18 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $41.69 / $83.18
| Professional | | $10.96 | $41.69 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $9.55 / $13.49
| Facility | 26 | $2.04 | $9.55 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $186.21
| Professional | | $30.20 | $47.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $12.02 / $43.65
| Professional | 26 | $6.61 | $12.02 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $147.91
| Professional | TC | $22.39 | $39.81 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $14.13 / $21.88
| Professional | 26 | $12.88 | $14.13 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $74.13
| Professional | | $23.44 | $35.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $9.77 / $18.20
| Professional | 26 | $6.46 | $9.77 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $26.30 / $51.29
| Professional | TC | $16.60 | $26.30 | $51.29 |