- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $83.18
| Facility | 26 | $69.18 | $69.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $288.40 / $489.78
| Professional | | $223.87 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $144.54
| Professional | 26 | $52.48 | $64.57 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Professional | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $44.67
| Professional | 26 | $42.66 | $43.65 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $257.04 / $436.52
| Professional | | $251.19 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $95.50
| Professional | 26 | $53.70 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $371.54 / $602.56
| Professional | | $251.19 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $107.15
| Professional | 26 | $48.98 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $302.00 / $398.11
| Professional | | $2.82 | $302.00 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.63 / $66.07 / $89.13
| Professional | 26 | $0.63 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $354.81
| Professional | | $2.82 | $2.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.63 / $0.63 / $83.18
| Professional | 26 | $0.63 | $0.63 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $234.42 / $239.88
| Professional | | $223.87 | $234.42 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $58.88
| Professional | 26 | $54.95 | $54.95 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $501.19
| Professional | | $213.80 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $102.33
| Professional | 26 | $43.65 | $54.95 | $102.33 |