- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $15.85 / $20.42
| Facility | 26 | $10.00 | $15.85 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $38.90 / $69.18
| Professional | | $16.98 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $40.74
| Professional | 26 | $10.00 | $16.98 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $52.48
| Professional | TC | $20.89 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $46.77
| Professional | | $25.70 | $38.02 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.30 / $16.60
| Professional | 26 | $9.55 | $12.30 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $33.88
| Professional | TC | $25.70 | $30.90 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $38.90 / $53.70
| Professional | | $12.88 | $38.90 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $19.95
| Facility | 26 | $12.02 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $60.26
| Professional | | $30.90 | $37.15 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $20.89
| Professional | 26 | $10.47 | $13.18 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $38.90
| Professional | TC | $19.95 | $25.70 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $100.00 / $100.00
| Facility | 26 | $30.20 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $269.15
| Professional | | $33.88 | $44.67 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.13 / $93.33
| Professional | 26 | $11.75 | $14.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $27.54 / $229.09
| Professional | TC | $21.38 | $27.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $69.18
| Professional | | $32.36 | $39.81 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $12.88 / $31.62
| Professional | 26 | $11.75 | $12.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $44.67
| Professional | TC | $20.89 | $26.30 | $44.67 |