- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $38.90 / $45.71
| Facility | 26 | $14.45 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $42.66 / $338.84
| Professional | | $21.88 | $42.66 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $54.95
| Professional | 26 | $8.91 | $12.02 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $22.91 / $190.55
| Professional | TC | $12.88 | $22.91 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $7.41 / $9.12
| Professional | 26 | $6.92 | $7.41 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $43.65
| Professional | | $21.88 | $27.54 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.33 / $14.79
| Professional | 26 | $7.41 | $9.33 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $18.20 / $29.51
| Professional | TC | $14.79 | $18.20 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $10.72 / $15.14
| Facility | 26 | $2.29 | $10.72 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $3.09 / $5.13 / $7.94
| Facility | 53 | $3.09 | $5.13 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $131.83
| Professional | | $19.95 | $35.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.48 / $20.89
| Professional | 26 | $7.76 | $11.48 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $22.39 / $117.49
| Professional | TC | $11.22 | $22.39 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $131.83 / $131.83
| Facility | 26 | $57.54 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $10.96 / $53.70 / $53.70
| Facility | 53 | $10.96 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $66.07 / $758.58
| Professional | | $19.95 | $66.07 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $11.22 / $131.83
| Professional | 26 | $8.32 | $11.22 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $47.86 / $707.95
| Professional | TC | $11.22 | $47.86 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $42.66 / $109.65
| Professional | | $19.95 | $42.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.00 / $58.88
| Professional | 26 | $8.32 | $10.00 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $20.42 / $85.11
| Professional | TC | $11.22 | $20.42 | $85.11 |