- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.02 / $57.54
| Facility | 26 | $9.55 | $12.02 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $275.42
| Professional | | $21.88 | $34.67 | $275.42 |
- 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 / $20.89 / $218.78
| Professional | TC | $12.88 | $20.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.24 / $7.76
| Professional | 26 | $7.08 | $7.24 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $20.89 / $28.84
| Professional | | $9.33 | $20.89 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $15.14
| Facility | 26 | $9.55 | $9.55 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $36.31 / $112.20
| Professional | | $18.20 | $36.31 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $15.14
| Professional | 26 | $7.94 | $10.00 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $23.99 / $87.10
| Professional | TC | $11.22 | $23.99 | $87.10 |
- 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
- $20.89 / $32.36 / $758.58
| Professional | | $20.89 | $32.36 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.96 / $131.83
| Professional | 26 | $8.51 | $10.96 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $22.91 / $707.95
| Professional | TC | $11.22 | $22.91 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $100.00
| Professional | | $19.95 | $26.30 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.00 / $23.44
| Professional | 26 | $8.51 | $10.00 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $13.49 / $79.43
| Professional | TC | $11.22 | $13.49 | $79.43 |