- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $11.22 / $19.05
| Facility | 26 | $10.00 | $11.22 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $79.43
| Professional | | $30.90 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.88 / $22.39
| Professional | 26 | $8.91 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $54.95
| Professional | TC | $21.88 | $28.84 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $32.36 / $52.48
| Professional | | $10.72 | $32.36 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.51 / $11.75 / $16.98
| Facility | 26 | $2.51 | $11.75 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $186.21
| Professional | | $28.84 | $51.29 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $15.14 / $58.88
| Professional | 26 | $8.32 | $15.14 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $35.48 / $128.82
| Professional | TC | $21.38 | $35.48 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $64.57
| Professional | | $58.88 | $58.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $27.54
| Professional | 26 | $15.85 | $21.88 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $74.13
| Professional | | $29.51 | $41.69 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.88 / $22.91
| Professional | 26 | $8.51 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $51.29
| Professional | TC | $19.95 | $30.90 | $51.29 |