- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $107.15
| Facility | 26 | $19.95 | $34.67 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $91.20
| Professional | | $33.88 | $52.48 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $43.65
| Professional | 26 | $19.05 | $23.99 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $69.18 / $109.65
| Professional | | $50.12 | $69.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $44.67
| Professional | 26 | $20.42 | $28.18 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $93.33
| Professional | | $32.36 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $22.91 / $40.74
| Professional | 26 | $20.42 | $22.91 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $56.23 / $117.49
| Professional | | $38.90 | $56.23 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $52.48
| Professional | 26 | $21.38 | $29.51 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $125.89
| Professional | | $40.74 | $58.88 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $51.29
| Professional | 26 | $16.98 | $23.44 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $100.00
| Professional | | $42.66 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $41.69
| Professional | 26 | $26.92 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $39.81 / $102.33
| Professional | | $16.22 | $39.81 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $47.86
| Professional | 26 | $21.38 | $26.92 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $93.33
| Professional | | $32.36 | $51.29 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $45.71
| Professional | 26 | $18.20 | $26.30 | $45.71 |