- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $22.39
| Facility | 26 | $10.96 | $15.85 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.20 / $34.67
| Professional | | $14.13 | $18.20 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.33 / $16.22
| Professional | 26 | $7.94 | $9.33 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $12.88
| Professional | TC | $6.03 | $7.94 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.96
| Professional | 26 | $10.00 | $10.00 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $25.12 / $50.12
| Professional | | $15.14 | $25.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.18 / $19.95
| Professional | 26 | $8.32 | $13.18 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.41 / $12.59 / $27.54
| Professional | TC | $7.41 | $12.59 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $100.00
| Facility | 26 | $23.44 | $23.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $208.93
| Professional | | $19.05 | $28.84 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $12.88 / $104.71
| Professional | 26 | $9.77 | $12.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.32 / $16.22 / $128.82
| Professional | TC | $8.32 | $16.22 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $36.31
| Professional | | $18.62 | $23.44 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $11.22 / $18.62
| Professional | 26 | $9.77 | $11.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.32 / $11.22 / $19.95
| Professional | TC | $8.32 | $11.22 | $19.95 |