- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Facility | 26 | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $67.61
| Professional | | $25.70 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $33.88
| Professional | 26 | $16.98 | $23.99 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | 52 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $29.51
| Professional | TC | $3.02 | $3.98 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Professional | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $51.29
| Professional | | $23.44 | $28.84 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.50 / $32.36
| Professional | 26 | $15.14 | $19.50 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.47 / $9.77 / $26.92
| Professional | TC | $3.47 | $9.77 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.79 / $35.48
| Professional | | $3.31 | $4.79 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $28.18 / $39.81
| Facility | 26 | $6.03 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $54.95 / $288.40
| Professional | | $26.92 | $54.95 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $28.84 / $114.82
| Professional | 26 | $18.62 | $28.84 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.02 / $37.15 / $144.54
| Professional | TC | $3.02 | $37.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $32.36 / $33.11
| Professional | | $7.41 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $45.71 / $70.79
| Professional | | $23.44 | $45.71 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $44.67
| Professional | 26 | $15.85 | $21.38 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.16 / $7.94 / $45.71
| Professional | TC | $3.16 | $7.94 | $45.71 |