- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $39.81 / $102.33
| Facility | 26 | $18.62 | $39.81 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $257.04
| Professional | | $85.11 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $43.65 / $89.13
| Professional | 26 | $23.44 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $21.88 / $57.54
| Professional | 26 | $21.38 | $21.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $257.04
| Professional | | $81.28 | $100.00 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $61.66
| Professional | 26 | $18.62 | $23.44 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $120.23 / $177.83
| Professional | | $56.23 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $43.65 / $61.66
| Facility | 26 | $9.33 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $478.63
| Professional | | $87.10 | $151.36 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $120.23
| Professional | 26 | $23.99 | $44.67 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $162.18 / $251.19
| Professional | | $123.03 | $162.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $56.23 / $93.33
| Professional | 26 | $38.02 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $154.88 / $288.40
| Professional | | $72.44 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $50.12 / $91.20
| Professional | 26 | $18.62 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $181.97
| Professional | | $125.89 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $37.15 / $93.33
| Professional | 26 | $36.31 | $37.15 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $165.96 / $316.23
| Professional | | $138.04 | $165.96 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $100.00
| Professional | 26 | $44.67 | $54.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $162.18 / $467.74
| Professional | | $102.33 | $162.18 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $138.04
| Professional | 26 | $31.62 | $48.98 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $75.86
| Facility | 26 | $25.12 | $44.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $154.88 / $288.40
| Professional | | $72.44 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $50.12 / $97.72
| Professional | 26 | $21.38 | $50.12 | $97.72 |