- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $3.31
| Facility | 26 | $2.00 | $2.00 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $28.84
| Professional | | $12.88 | $16.98 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $5.62
| Professional | 26 | $2.00 | $3.02 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $22.91
| Professional | TC | $10.00 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $16.22 / $21.88
| Professional | | $3.47 | $16.22 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $25.70 / $36.31
| Professional | | $15.85 | $25.70 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $6.17 / $8.91
| Professional | 26 | $3.09 | $6.17 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $26.92
| Professional | TC | $12.88 | $19.95 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $100.00
| Facility | 26 | $5.89 | $5.89 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $162.18
| Professional | | $16.98 | $24.55 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.89 / $6.03 / $53.70
| Professional | 26 | $3.89 | $6.03 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $128.82
| Professional | TC | $14.45 | $20.89 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $33.88
| Professional | | $17.38 | $23.44 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $5.01 / $7.76
| Professional | 26 | $3.63 | $5.01 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $18.20 / $26.92
| Professional | TC | $13.80 | $18.20 | $26.92 |