- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $21.88
| Facility | 26 | $12.02 | $19.05 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $97.72
| Professional | | $22.91 | $36.31 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.91 / $21.88
| Professional | 26 | $7.08 | $8.91 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $10.00 / $14.13
| Facility | 26 | $2.14 | $10.00 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $63.10 / $97.72
| Professional | | $33.11 | $63.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.22 / $25.12
| Professional | 26 | $9.55 | $16.22 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $75.86 / $93.33
| Professional | | $67.61 | $75.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $19.05 / $22.39
| Professional | 26 | $16.60 | $19.05 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $21.88
| Facility | 26 | $12.02 | $19.05 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $104.71
| Professional | | $42.66 | $67.61 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $26.30
| Professional | 26 | $12.02 | $18.20 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $30.90 / $52.48
| Professional | | $14.45 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $97.72
| Professional | | $52.48 | $69.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $25.12
| Professional | 26 | $12.02 | $18.20 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $74.13 / $100.00
| Professional | | $58.88 | $74.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $18.62 / $25.12
| Professional | 26 | $15.85 | $18.62 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $38.90 / $91.20
| Professional | | $29.51 | $38.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.96 / $23.99
| Professional | 26 | $8.71 | $10.96 | $23.99 |