- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $19.05 / $79.43
| Facility | 26 | $10.00 | $19.05 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $75.86
| Professional | | $33.88 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $30.20
| Professional | 26 | $8.91 | $12.02 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $60.26
| Professional | TC | $23.99 | $34.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $53.70
| Professional | | $29.51 | $29.51 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $9.55
| Professional | 26 | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $43.65 / $60.26
| Professional | | $12.59 | $43.65 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $19.05
| Facility | 26 | $11.75 | $11.75 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $66.07
| Professional | | $33.11 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $12.59 / $20.42
| Professional | 26 | $10.23 | $12.59 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $30.20 / $43.65
| Professional | TC | $22.39 | $30.20 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $100.00 / $100.00
| Facility | 26 | $29.51 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $309.03
| Professional | | $38.02 | $50.12 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $95.50
| Professional | 26 | $11.75 | $13.80 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $251.19
| Professional | TC | $25.70 | $32.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $44.67 / $74.13
| Professional | | $36.31 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $12.88 / $25.70
| Professional | 26 | $11.48 | $12.88 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $52.48
| Professional | TC | $24.55 | $30.90 | $52.48 |