- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $870.96
| Facility | 26 | $64.57 | $123.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $389.05
| Professional | | $107.15 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $177.83
| Professional | 26 | $64.57 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $151.36
| Professional | 26 | $72.44 | $102.33 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $257.04
| Professional | | $52.48 | $67.61 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $107.15 / $181.97
| Facility | 26 | $22.91 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $204.17 / $630.96
| Professional | | $112.20 | $204.17 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $100.00 / $199.53
| Professional | 26 | $66.07 | $100.00 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $562.34
| Professional | | $112.20 | $186.21 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $85.11 / $131.83
| Professional | 26 | $66.07 | $85.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $177.83
| Professional | | $32.36 | $72.44 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $190.55 / $446.68
| Professional | | $131.83 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $169.82
| Professional | 26 | $70.79 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $162.18
| Professional | | $112.20 | $112.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $97.72
| Professional | 26 | $66.07 | $66.07 | $97.72 |