- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $194.98
| Facility | 26 | $70.79 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $616.60
| Professional | | $194.98 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $72.44 / $147.91
| Professional | 26 | $52.48 | $72.44 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $269.15 / $645.65
| Professional | | $218.78 | $269.15 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $128.82
| Professional | 26 | $52.48 | $64.57 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $213.80 / $302.00
| Professional | | $87.10 | $213.80 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $69.18 / $97.72
| Facility | 26 | $14.79 | $69.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $436.52 / $1,479.11
| Professional | | $204.17 | $436.52 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $89.13 / $245.47
| Professional | 26 | $46.77 | $89.13 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $416.87
| Professional | | $208.93 | $275.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $251.19
| Professional | 26 | $58.88 | $83.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $316.23 / $512.86
| Professional | | $186.21 | $316.23 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $87.10 / $151.36
| Professional | 26 | $48.98 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $281.84
| Professional | | $251.19 | $251.19 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $123.03
| Professional | 26 | $72.44 | $72.44 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $316.23 / $537.03
| Professional | | $263.03 | $316.23 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $158.49
| Professional | 26 | $72.44 | $87.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $794.33
| Professional | | $194.98 | $302.00 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $218.78
| Professional | 26 | $53.70 | $79.43 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $204.17
| Facility | 26 | $48.98 | $70.79 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $588.84
| Professional | | $186.21 | $309.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $87.10 / $173.78
| Professional | 26 | $48.98 | $87.10 | $173.78 |