- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $51.29 / $51.29
| Facility | 26 | $12.30 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $56.23 / $302.00
| Professional | | $22.91 | $56.23 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $54.95
| Professional | 26 | $8.91 | $12.59 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $28.18 / $218.78
| Professional | TC | $12.88 | $28.18 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $47.86
| Professional | | $17.38 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.72 / $17.78
| Professional | 26 | $7.24 | $10.72 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $74.13
| Professional | | $12.88 | $16.60 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $10.72 / $18.20
| Facility | 26 | $2.29 | $10.72 | $18.20 |
- 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
- $16.98 / $32.36 / $141.25
| Professional | | $16.98 | $32.36 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $11.22 / $22.39
| Professional | 26 | $6.61 | $11.22 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $22.39 / $134.90
| Professional | TC | $10.00 | $22.39 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $10.47
| Facility | 26 | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $29.51 / $114.82
| Professional | | $17.38 | $29.51 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $9.12 / $13.49
| Professional | 26 | $6.61 | $9.12 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $104.71
| Professional | TC | $10.96 | $16.98 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $20.42 / $33.11
| Professional | | $7.94 | $20.42 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $107.15
| Professional | | $18.20 | $30.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.77 / $22.39
| Professional | 26 | $7.59 | $9.77 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $16.60 / $85.11
| Professional | TC | $10.23 | $16.60 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $26.30
| Professional | | $19.50 | $19.50 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $9.77
| Professional | 26 | $7.08 | $7.08 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $16.60
| Professional | TC | $12.59 | $12.59 | $16.60 |