- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $218.78
| Facility | 26 | $36.31 | $36.31 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $165.96
| Professional | | $74.13 | $100.00 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $38.02 / $70.79
| Professional | 26 | $32.36 | $38.02 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $269.15 / $338.84
| Professional | | $107.15 | $269.15 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $97.72 / $123.03
| Professional | 26 | $41.69 | $97.72 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $398.11
| Professional | | $102.33 | $165.96 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $158.49
| Professional | 26 | $38.90 | $74.13 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $190.55
| Facility | 26 | $128.82 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $676.08
| Professional | | $100.00 | $181.97 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $281.84
| Professional | 26 | $41.69 | $60.26 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $239.88 / $269.15
| Professional | | $213.80 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $128.82
| Professional | 26 | $83.18 | $97.72 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $269.15
| Professional | | $186.21 | $263.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $104.71
| Professional | 26 | $81.28 | $97.72 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $251.19
| Professional | | $95.50 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $102.33
| Professional | 26 | $41.69 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $223.87
| Professional | | $190.55 | $190.55 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $83.18
| Professional | 26 | $70.79 | $70.79 | $83.18 |