- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $36.31
| Facility | 26 | $30.20 | $30.20 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $239.88 / $776.25
| Professional | | $147.91 | $239.88 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $158.49
| Professional | 26 | $25.12 | $37.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $204.17 / $338.84
| Professional | | $177.83 | $204.17 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $45.71
| Professional | 26 | $28.18 | $28.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $398.11
| Professional | | $151.36 | $269.15 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $45.71 / $56.23
| Professional | 26 | $24.55 | $45.71 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $251.19 / $331.13
| Professional | | $1.05 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.32 / $38.02 / $46.77
| Professional | 26 | $0.32 | $38.02 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.05 / $302.00
| Professional | | $1.05 | $1.05 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.32 / $0.32 / $41.69
| Professional | 26 | $0.32 | $0.32 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $199.53 / $199.53
| Professional | | $190.55 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $28.18 / $28.18
| Professional | 26 | $27.54 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $199.53 / $316.23
| Professional | | $30.90 | $199.53 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $60.26
| Professional | 26 | $23.99 | $37.15 | $60.26 |