- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $12.88 / $23.44
| Facility | 26 | $11.75 | $12.88 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $181.97
| Professional | | $64.57 | $85.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $169.82
| Professional | | $66.07 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $63.10 / $97.72
| Professional | | $15.49 | $63.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $158.49
| Professional | | $74.13 | $104.71 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.47 / $20.42 / $29.51
| Facility | 26 | $4.47 | $20.42 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $177.83
| Professional | | $64.57 | $89.13 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 26 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $758.58 / $758.58
| Professional | | $630.96 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $15.14 / $23.99
| Facility | 26 | $11.75 | $15.14 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $208.93
| Professional | | $64.57 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $56.23
| Professional | | $15.14 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $93.33 / $181.97
| Professional | | $18.62 | $93.33 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.47 / $20.89 / $30.20
| Facility | 26 | $4.47 | $20.89 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $190.55
| Professional | | $64.57 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $158.49
| Professional | | $69.18 | $87.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $107.15
| Professional | | $85.11 | $89.13 | $107.15 |