- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $177.83
| Facility | 26 | $104.71 | $151.36 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $537.03 / $1,047.13
| Professional | | $426.58 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $190.55
| Professional | 26 | $72.44 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $954.99 / $1,258.93
| Professional | | $457.09 | $954.99 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $151.36 / $204.17
| Professional | 26 | $72.44 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $912.01 / $1,148.15
| Professional | | $741.31 | $912.01 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $181.97
| Professional | 26 | $114.82 | $151.36 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $177.83
| Facility | 26 | $104.71 | $151.36 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $831.76 / $1,318.26
| Professional | | $602.56 | $831.76 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $223.87
| Professional | 26 | $109.65 | $141.25 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $630.96
| Professional | | $117.49 | $177.83 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $912.01 / $1,202.26
| Professional | | $645.65 | $912.01 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $204.17
| Professional | 26 | $97.72 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,023.29 / $1,258.93
| Professional | | $812.83 | $1,023.29 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $208.93
| Professional | 26 | $131.83 | $165.96 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $398.11 / $1,122.02
| Professional | | $354.81 | $398.11 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $66.07 / $186.21
| Professional | 26 | $63.10 | $66.07 | $186.21 |