- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $19.05 / $29.51
| Facility | 26 | $15.49 | $19.05 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $117.49
| Professional | | $61.66 | $77.62 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $61.66 / $91.20
| Professional | | $20.42 | $61.66 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $25.70 / $37.15
| Facility | 26 | $5.62 | $25.70 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $190.55
| Professional | | $64.57 | $91.20 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | 26 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $19.05 / $30.20
| Facility | 26 | $15.49 | $19.05 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $173.78
| Professional | | $61.66 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $33.11 / $66.07
| Professional | | $18.62 | $33.11 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $218.78 / $251.19
| Professional | | $97.72 | $218.78 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $27.54 / $39.81
| Facility | 26 | $5.89 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $91.20 / $199.53
| Professional | | $67.61 | $91.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $91.20 / $158.49
| Professional | | $72.44 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $85.11 / $102.33
| Professional | | $81.28 | $85.11 | $102.33 |