- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $141.25 / $194.98
| Facility | 26 | $107.15 | $141.25 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $588.84
| Professional | | $234.42 | $316.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $436.52
| Professional | 26 | $97.72 | $134.90 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $213.80
| Professional | 26 | $95.50 | $158.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $338.84
| Professional | 26 | $154.88 | $251.19 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $120.23 / $169.82
| Facility | 26 | $25.70 | $120.23 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $72.44
| Facility | 53 | $33.88 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $707.95
| Professional | | $257.04 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $288.40
| Professional | 26 | $109.65 | $162.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $467.74
| Professional | | $371.54 | $371.54 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $169.82 / $199.53
| Professional | 26 | $162.18 | $169.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $616.60
| Professional | | $371.54 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $1,230.27
| Professional | | $165.96 | $371.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $616.60
| Professional | | $234.42 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $131.83 / $239.88
| Professional | 26 | $97.72 | $131.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | 26 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | 53 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Professional | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $831.76 / $1,023.29 / $1,023.29
| Professional | 26 | $831.76 | $1,023.29 | $1,023.29 |