- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $33.11
| Facility | 26 | $19.05 | $30.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $186.21
| Professional | | $61.66 | $81.28 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $39.81
| Professional | 26 | $18.20 | $24.55 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $26.30 / $26.30
| Professional | 26 | $23.44 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $81.28
| Professional | | $32.36 | $51.29 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $15.85 / $25.70
| Professional | 26 | $13.49 | $15.85 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $54.95 / $87.10
| Professional | | $19.50 | $54.95 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.68 / $21.38 / $30.90
| Facility | 26 | $4.68 | $21.38 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $100.00 / $346.74
| Professional | | $45.71 | $100.00 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $89.13
| Professional | 26 | $18.20 | $28.84 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $32.36 / $33.11
| Professional | | $5.62 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $138.04
| Professional | | $37.15 | $69.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $21.88 / $38.90
| Professional | 26 | $16.60 | $21.88 | $38.90 |