- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | 26 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $229.09
| Professional | | $89.13 | $112.20 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $100.00
| Professional | 26 | $32.36 | $48.98 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $40.74 / $40.74
| Facility | 26 | $33.88 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $380.19
| Professional | | $173.78 | $263.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $173.78
| Professional | 26 | $79.43 | $120.23 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $173.78 / $416.87
| Facility | 26 | $74.13 | $173.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $323.59
| Professional | | $117.49 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $89.13 / $144.54
| Professional | 26 | $40.74 | $89.13 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $169.82 / $331.13
| Facility | 26 | $134.90 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $269.15
| Professional | | $162.18 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $117.49
| Professional | 26 | $70.79 | $70.79 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $186.21 / $794.33
| Professional | | $102.33 | $186.21 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $309.03
| Professional | 26 | $35.48 | $63.10 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $331.13
| Professional | | $104.71 | $186.21 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $138.04 / $263.03
| Professional | 26 | $42.66 | $138.04 | $263.03 |