- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $251.19
| Facility | 26 | $32.36 | $42.66 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $257.04
| Professional | | $75.86 | $114.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $38.90 / $70.79
| Professional | 26 | $30.90 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $104.71 / $144.54
| Professional | | $39.81 | $104.71 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $61.66
| Facility | 26 | $37.15 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $302.00
| Professional | | $85.11 | $125.89 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $40.74 / $64.57
| Professional | 26 | $33.88 | $40.74 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $177.83
| Facility | 26 | $93.33 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $1,949.84
| Professional | | $89.13 | $138.04 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $549.54
| Professional | 26 | $37.15 | $43.65 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $104.71 / $239.88
| Professional | | $87.10 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $41.69 / $60.26
| Professional | 26 | $36.31 | $41.69 | $60.26 |