- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Facility | 26 | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $56.23 / $67.61
| Professional | | $46.77 | $56.23 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $70.79
| Professional | 26 | $19.05 | $25.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $39.81
| Professional | TC | $28.18 | $34.67 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $69.18
| Professional | | $18.20 | $18.20 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $41.69
| Professional | 26 | $12.02 | $12.02 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.46 / $7.24 / $25.70
| Professional | TC | $6.46 | $7.24 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $77.62
| Professional | | $30.20 | $35.48 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $32.36 / $46.77
| Facility | 26 | $6.92 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $64.57 / $371.54
| Professional | | $34.67 | $64.57 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $33.88 / $141.25
| Professional | 26 | $12.88 | $33.88 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $245.47
| Professional | TC | $18.62 | $30.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $131.83
| Professional | | $43.65 | $63.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $66.07
| Professional | 26 | $20.89 | $29.51 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $75.86
| Professional | TC | $20.42 | $35.48 | $75.86 |