- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Facility | 26 | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $120.23
| Professional | | $33.88 | $56.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $79.43
| Professional | 26 | $19.05 | $23.99 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $19.05 / $19.95
| Facility | 26 | $16.60 | $19.05 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $125.89 / $186.21
| Professional | | $75.86 | $125.89 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $77.62
| Professional | 26 | $30.90 | $52.48 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $186.21
| Facility | 26 | $54.95 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $144.54 / $223.87
| Professional | | $87.10 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $58.88 / $91.20
| Professional | 26 | $36.31 | $58.88 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $147.91
| Facility | 26 | $61.66 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $204.17
| Professional | | $87.10 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $83.18
| Professional | 26 | $35.48 | $53.70 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Facility | 26 | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $91.20 / $245.47
| Professional | | $48.98 | $91.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $46.77 / $117.49
| Professional | 26 | $24.55 | $46.77 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $102.33 / $181.97
| Professional | | $50.12 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $45.71 / $83.18
| Professional | 26 | $26.30 | $45.71 | $83.18 |