- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $112.20
| Facility | 26 | $21.38 | $31.62 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $134.90 / $218.78
| Professional | | $117.49 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $42.66
| Professional | 26 | $20.89 | $23.99 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $316.23 / $457.09
| Professional | | $158.49 | $316.23 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $45.71 / $64.57
| Professional | 26 | $25.12 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $501.19 / $602.56
| Professional | | $141.25 | $501.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $83.18
| Professional | 26 | $22.91 | $31.62 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | 26 | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $851.14
| Professional | | $158.49 | $269.15 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $147.91
| Professional | 26 | $25.70 | $41.69 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $309.03 / $501.19
| Professional | | $223.87 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $95.50
| Professional | 26 | $40.74 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $346.74 / $380.19
| Professional | | $316.23 | $346.74 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $58.88 / $63.10
| Professional | 26 | $56.23 | $58.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $407.38
| Professional | | $158.49 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $67.61
| Professional | 26 | $25.70 | $38.02 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $316.23
| Professional | | $269.15 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $48.98
| Professional | 26 | $41.69 | $41.69 | $48.98 |