- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $123.03
| Facility | 26 | $67.61 | $109.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $281.84
| Professional | | $89.13 | $125.89 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $123.03
| Professional | 26 | $31.62 | $50.12 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $54.95 / $79.43
| Facility | 26 | $11.75 | $54.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $213.80 / $316.23
| Professional | | $109.65 | $213.80 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $131.83
| Professional | 26 | $38.90 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $239.88 / $281.84
| Professional | | $208.93 | $239.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $104.71 / $123.03
| Professional | 26 | $91.20 | $104.71 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $123.03
| Facility | 26 | $67.61 | $109.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $218.78 / $331.13
| Professional | | $125.89 | $218.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $97.72 / $144.54
| Professional | 26 | $44.67 | $97.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $91.20 / $151.36
| Professional | | $39.81 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $234.42 / $316.23
| Professional | | $173.78 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $134.90
| Professional | 26 | $51.29 | $77.62 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | 26 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $234.42 / $309.03
| Professional | | $199.53 | $234.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $138.04
| Professional | 26 | $67.61 | $100.00 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $309.03
| Professional | | $104.71 | $138.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $51.29 / $125.89
| Professional | 26 | $34.67 | $51.29 | $125.89 |