- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.96 / $18.20
| Facility | 26 | $10.00 | $10.96 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $93.33
| Professional | | $28.18 | $38.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.88 / $30.20
| Professional | 26 | $8.91 | $12.88 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $60.26
| Professional | TC | $19.95 | $28.18 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $97.72
| Professional | | $66.07 | $87.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $26.30
| Professional | 26 | $18.20 | $23.99 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $70.79
| Professional | TC | $47.86 | $63.10 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $95.50
| Professional | | $38.02 | $57.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $26.92
| Professional | 26 | $10.96 | $16.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $66.07
| Professional | TC | $27.54 | $42.66 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $67.61 / $263.03
| Professional | | $36.31 | $67.61 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $22.91 / $107.15
| Professional | 26 | $10.96 | $22.91 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $45.71 / $251.19
| Professional | TC | $25.70 | $45.71 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $66.07 / $100.00
| Professional | | $37.15 | $66.07 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.05 / $38.90
| Professional | 26 | $11.75 | $19.05 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $47.86 / $100.00
| Professional | TC | $25.70 | $47.86 | $100.00 |