- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.45 / $3.72 / $3.72
| Facility | 26 | $2.45 | $3.72 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $37.15
| Professional | | $12.88 | $19.95 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $8.51
| Professional | 26 | $2.00 | $3.98 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $25.12
| Professional | TC | $10.96 | $15.14 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $16.22 / $17.78
| Professional | | $13.18 | $16.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $2.69
| Professional | 26 | $2.29 | $2.29 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $31.62 / $37.15
| Professional | | $15.85 | $31.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.95 / $5.89 / $7.08
| Professional | 26 | $2.95 | $5.89 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $30.20
| Professional | TC | $12.88 | $25.70 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $52.48
| Professional | | $16.60 | $28.84 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $6.61 / $10.00
| Professional | 26 | $3.09 | $6.61 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $21.38 / $42.66
| Professional | TC | $13.49 | $21.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $31.62
| Professional | | $15.85 | $21.38 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.31 / $4.90 / $7.08
| Professional | 26 | $3.31 | $4.90 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $16.98 / $25.12
| Professional | TC | $12.59 | $16.98 | $25.12 |