- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $60.26
| Facility | 26 | $50.12 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $199.53
| Professional | | $89.13 | $125.89 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $102.33
| Professional | 26 | $31.62 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | 26 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $173.78
| Professional | | $104.71 | $104.71 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $72.44
| Professional | 26 | $33.88 | $46.77 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $190.55
| Professional | | $83.18 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $47.86 / $81.28
| Professional | 26 | $29.51 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $128.82 / $177.83
| Professional | | $0.72 | $128.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.21 / $54.95 / $75.86
| Professional | 26 | $0.21 | $54.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.72 / $158.49
| Professional | | $0.72 | $0.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.21 / $0.21 / $70.79
| Professional | 26 | $0.21 | $0.21 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $107.15 / $112.20
| Professional | | $102.33 | $107.15 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $47.86 / $50.12
| Professional | 26 | $45.71 | $47.86 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $177.83
| Professional | | $74.13 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $64.57
| Professional | 26 | $25.70 | $35.48 | $64.57 |