- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $13.49 / $19.95
| Facility | 26 | $10.00 | $13.49 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $169.82
| Professional | | $28.18 | $40.74 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.79 / $53.70
| Professional | 26 | $8.91 | $14.79 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $38.90
| Professional | TC | $18.20 | $21.88 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.84
| Professional | | $28.18 | $28.18 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.47 / $14.45
| Professional | 26 | $8.13 | $10.47 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $42.66
| Professional | | $28.18 | $33.11 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $18.20
| Professional | 26 | $12.02 | $14.13 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $18.62 / $24.55
| Professional | TC | $15.85 | $18.62 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $19.50 / $35.48
| Professional | | $10.72 | $19.50 | $35.48 |
- 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
- $28.18 / $47.86 / $141.25
| Professional | | $28.18 | $47.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $18.62 / $47.86
| Professional | 26 | $10.72 | $18.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $93.33
| Professional | TC | $17.78 | $30.20 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $32.36 / $33.11
| Professional | | $11.75 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $67.61
| Professional | | $31.62 | $39.81 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $26.92
| Professional | 26 | $12.59 | $15.85 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $41.69
| Professional | TC | $18.62 | $23.44 | $41.69 |