- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Facility | 26 | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $112.20
| Professional | | $38.02 | $53.70 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $38.02
| Professional | 26 | $10.96 | $14.13 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $63.10
| Professional | TC | $25.12 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $53.70
| Professional | | $38.02 | $40.74 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $67.61
| Professional | | $36.31 | $52.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.79 / $18.62
| Professional | 26 | $10.23 | $14.79 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $47.86
| Professional | TC | $26.30 | $38.02 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $120.23
| Professional | | $38.90 | $63.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $37.15
| Professional | 26 | $12.02 | $19.05 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $91.20
| Professional | TC | $31.62 | $46.77 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $95.50
| Professional | | $37.15 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.14 / $87.10
| Professional | 26 | $10.72 | $15.14 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $54.95
| Professional | TC | $26.30 | $36.31 | $54.95 |