- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.50 / $26.92
| Facility | 26 | $15.14 | $19.50 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $43.65 / $97.72
| Professional | | $33.88 | $43.65 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $43.65
| Professional | 26 | $12.88 | $15.14 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $42.66
| Professional | TC | $19.05 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $66.07
| Professional | | $38.02 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.49 / $19.95
| Professional | 26 | $15.14 | $15.49 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $87.10
| Professional | | $41.69 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.42 / $31.62
| Professional | 26 | $15.85 | $20.42 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $60.26
| Professional | TC | $23.99 | $34.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $93.33
| Professional | | $37.15 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $33.88
| Professional | 26 | $14.13 | $19.95 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $38.90 / $63.10
| Professional | TC | $24.55 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $83.18
| Professional | | $37.15 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $17.78 / $32.36
| Professional | 26 | $14.45 | $17.78 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $29.51 / $51.29
| Professional | TC | $22.39 | $29.51 | $51.29 |