- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $48.98 / $114.82
| Facility | 26 | $22.91 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $602.56
| Professional | | $144.54 | $213.80 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $131.83
| Professional | 26 | $22.91 | $30.90 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $186.21
| Facility | 26 | $32.36 | $72.44 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $257.04 / $1,047.13
| Professional | | $162.18 | $257.04 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $257.04
| Professional | 26 | $21.88 | $36.31 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $57.54 / $87.10
| Professional | 26 | $46.77 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $380.19 / $707.95
| Professional | | $177.83 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $87.10
| Professional | 26 | $35.48 | $58.88 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $245.47 / $363.08
| Professional | | $37.15 | $245.47 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $575.44
| Professional | | $204.17 | $263.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $74.13
| Professional | 26 | $28.84 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $186.21
| Facility | 26 | $32.36 | $72.44 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $257.04 / $1,047.13
| Professional | | $162.18 | $257.04 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $257.04
| Professional | 26 | $21.88 | $36.31 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $331.13 / $851.14
| Professional | | $162.18 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $85.11
| Professional | 26 | $29.51 | $43.65 | $85.11 |