- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Facility | 26 | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $478.63
| Professional | | $46.77 | $91.20 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $25.12 / $141.25
| Professional | 26 | $12.02 | $25.12 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $9.77 / $9.77
| Facility | 26 | $8.13 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $162.18
| Professional | | $79.43 | $114.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $41.69
| Professional | 26 | $20.42 | $29.51 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $41.69 / $102.33
| Facility | 26 | $19.05 | $41.69 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $190.55
| Professional | | $70.79 | $89.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $21.88 / $36.31
| Professional | 26 | $13.49 | $21.88 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $81.28
| Facility | 26 | $33.11 | $40.74 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $190.55
| Professional | | $70.79 | $70.79 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $28.84
| Professional | 26 | $17.38 | $17.38 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $100.00 / $354.81
| Professional | | $53.70 | $100.00 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $20.89 / $74.13
| Professional | 26 | $12.02 | $20.89 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $93.33 / $158.49
| Professional | | $51.29 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $72.44 / $95.50
| Professional | 26 | $13.80 | $72.44 | $95.50 |