- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $37.15 / $83.18
| Facility | 26 | $19.95 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $70.79 / $204.17
| Professional | | $31.62 | $70.79 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $45.71 / $117.49
| Professional | 26 | $19.05 | $45.71 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $36.31 / $70.79 / $257.04
| Professional | 50 | $36.31 | $70.79 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.91 / $28.18 / $81.28
| Professional | TC | $8.91 | $28.18 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Facility | 26 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $102.33
| Professional | | $30.90 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $56.23
| Professional | 26 | $19.50 | $27.54 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $151.36
| Professional | 50 | $48.98 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $21.38 / $50.12
| Professional | TC | $10.00 | $21.38 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $42.66 / $117.49
| Facility | 26 | $7.94 | $42.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $144.54
| Professional | | $32.36 | $58.88 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $75.86
| Professional | 26 | $20.89 | $33.11 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.88 / $74.13 / $87.10
| Professional | 50 | $33.88 | $74.13 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $26.92 / $75.86
| Professional | TC | $10.47 | $26.92 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $144.54
| Professional | | $33.11 | $61.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $95.50
| Professional | 26 | $19.95 | $31.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $33.11 / $85.11
| Professional | TC | $10.72 | $33.11 | $85.11 |