- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | 26 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $602.56
| Professional | | $208.93 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $57.54 / $102.33
| Professional | 26 | $44.67 | $57.54 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $47.86
| Facility | 26 | $39.81 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $812.83 / $1,174.90
| Professional | | $478.63 | $812.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $190.55
| Professional | 26 | $79.43 | $134.90 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $194.98 / $478.63
| Facility | 26 | $87.10 | $194.98 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $851.14 / $1,412.54
| Professional | | $263.03 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $138.04 / $229.09
| Professional | 26 | $61.66 | $138.04 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $190.55 / $380.19
| Facility | 26 | $154.88 | $190.55 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $851.14 / $1,288.25
| Professional | | $562.34 | $851.14 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $208.93
| Professional | 26 | $95.50 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $398.11 / $1,659.59
| Professional | | $223.87 | $398.11 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $95.50 / $338.84
| Professional | 26 | $53.70 | $95.50 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $912.01
| Professional | | $234.42 | $398.11 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $169.82
| Professional | 26 | $53.70 | $87.10 | $169.82 |