- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $61.66
| Facility | 26 | $43.65 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $380.19
| Professional | | $147.91 | $213.80 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $44.67
| Professional | 26 | $22.91 | $28.84 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $316.23 / $1,122.02
| Professional | | $204.17 | $316.23 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $158.49
| Professional | 26 | $28.84 | $44.67 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $141.25
| Facility | 26 | $75.86 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $741.31 / $831.76
| Professional | | $316.23 | $741.31 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $104.71 / $117.49
| Professional | 26 | $43.65 | $104.71 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $602.56
| Professional | | $407.38 | $467.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $67.61 / $81.28
| Professional | 26 | $57.54 | $67.61 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $1,412.54
| Professional | | $213.80 | $363.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $251.19
| Professional | 26 | $33.11 | $61.66 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $239.88
| Professional | | $32.36 | $33.11 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $2,137.96
| Professional | | $302.00 | $426.58 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $109.65
| Professional | 26 | $41.69 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $912.01
| Professional | | $323.59 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $186.21
| Facility | 26 | $100.00 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,122.02 / $1,412.54
| Professional | | $331.13 | $1,122.02 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $151.36 / $251.19
| Professional | 26 | $47.86 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Professional | 26 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,288.25 / $1,698.24
| Professional | | $478.63 | $1,288.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $169.82
| Professional | 26 | $81.28 | $102.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $338.84 / $851.14
| Professional | | $190.55 | $338.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $83.18 / $213.80
| Professional | 26 | $34.67 | $83.18 | $213.80 |