- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $91.20
| Facility | 26 | $28.84 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $295.12
| Professional | | $97.72 | $134.90 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $67.61
| Professional | 26 | $20.89 | $28.84 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $275.42
| Professional | | $87.10 | $109.65 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $60.26
| Professional | 26 | $22.39 | $27.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $416.87
| Professional | 50 | $128.82 | $162.18 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $165.96 / $204.17
| Professional | | $39.81 | $165.96 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $34.67 / $48.98
| Facility | 26 | $7.41 | $34.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $524.81
| Professional | | $100.00 | $169.82 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $41.69 / $109.65
| Professional | 26 | $21.88 | $41.69 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $158.49 / $239.88
| Professional | | $125.89 | $158.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $112.20
| Professional | 26 | $32.36 | $44.67 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $257.04
| Professional | | $89.13 | $138.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $72.44
| Professional | 26 | $23.44 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $57.54
| Professional | 26 | $31.62 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $186.21 / $288.40
| Professional | | $151.36 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $81.28
| Professional | 26 | $33.11 | $39.81 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $426.58
| Professional | | $107.15 | $151.36 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $128.82
| Professional | 26 | $25.70 | $39.81 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $87.10
| Facility | 26 | $25.12 | $35.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $295.12
| Professional | | $89.13 | $138.04 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $85.11
| Professional | 26 | $25.12 | $39.81 | $85.11 |