- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | 26 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $83.18
| Professional | | $53.70 | $64.57 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $43.65 / $57.54
| Professional | 26 | $38.02 | $43.65 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $66.07 / $109.65
| Professional | | $64.57 | $66.07 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $45.71 / $75.86
| Professional | 26 | $44.67 | $45.71 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $141.25
| Professional | | $63.10 | $81.28 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $97.72
| Professional | 26 | $42.66 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $128.82
| Professional | | $63.10 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $87.10
| Professional | 26 | $42.66 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $120.23
| Professional | | $61.66 | $70.79 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $83.18
| Professional | 26 | $42.66 | $50.12 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | 26 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $64.57 / $83.18
| Professional | | $56.23 | $64.57 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $44.67 / $57.54
| Professional | 26 | $38.90 | $44.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $165.96
| Professional | | $93.33 | $109.65 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $50.12 / $50.12
| Facility | 26 | $43.65 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $309.03
| Professional | | $45.71 | $64.57 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $50.12
| Professional | 26 | $42.66 | $43.65 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $120.23
| Professional | | $53.70 | $75.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $87.10
| Professional | 26 | $38.02 | $53.70 | $87.10 |