- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | 26 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $97.72
| Professional | | $37.15 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $38.90
| Professional | 26 | $18.20 | $21.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $17.78 / $18.62
| Facility | 26 | $15.49 | $17.78 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $123.03 / $181.97
| Professional | | $74.13 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $50.12 / $72.44
| Professional | 26 | $29.51 | $50.12 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $181.97
| Facility | 26 | $53.70 | $75.86 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $141.25 / $218.78
| Professional | | $87.10 | $141.25 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $87.10
| Professional | 26 | $34.67 | $56.23 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $72.44 / $141.25
| Facility | 26 | $57.54 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $199.53
| Professional | | $85.11 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $79.43
| Professional | 26 | $33.88 | $51.29 | $79.43 |
- 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
- $45.71 / $85.11 / $229.09
| Professional | | $45.71 | $85.11 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $42.66 / $109.65
| Professional | 26 | $23.44 | $42.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $97.72 / $177.83
| Professional | | $46.77 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $77.62
| Professional | 26 | $25.12 | $42.66 | $77.62 |