- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $23.99
| Facility | 26 | $20.89 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $69.18
| Professional | | $29.51 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $47.86
| Professional | 26 | $19.95 | $26.92 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $11.22 / $18.20
| Professional | TC | $10.00 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $27.54 / $51.29
| Professional | | $11.48 | $27.54 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $25.12 / $35.48
| Facility | 26 | $5.37 | $25.12 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $162.18
| Professional | | $32.36 | $43.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $102.33
| Professional | 26 | $20.89 | $28.84 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $14.79 / $58.88
| Professional | TC | $11.22 | $14.79 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $45.71 / $45.71
| Professional | | $43.65 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $45.71
| Professional | 26 | $27.54 | $44.67 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $17.78
| Professional | TC | $16.22 | $16.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $57.54
| Professional | | $25.70 | $35.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $38.02
| Professional | 26 | $16.98 | $23.99 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $19.50
| Professional | TC | $7.94 | $12.02 | $19.50 |