- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $52.48 / $56.23
| Facility | 26 | $28.84 | $52.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $144.54 / $346.74
| Professional | | $117.49 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $51.29
| Professional | 26 | $20.89 | $25.12 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $426.58
| Professional | | $158.49 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $64.57
| Professional | 26 | $25.12 | $41.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $316.23 / $398.11
| Professional | | $288.40 | $316.23 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $47.86 / $56.23
| Professional | 26 | $42.66 | $47.86 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $56.23
| Facility | 26 | $28.84 | $51.29 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $426.58
| Professional | | $165.96 | $302.00 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $47.86 / $67.61
| Professional | 26 | $25.70 | $47.86 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $245.47
| Professional | | $30.90 | $50.12 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $316.23 / $426.58
| Professional | | $239.88 | $316.23 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $66.07
| Professional | 26 | $30.20 | $47.86 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 26 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $338.84 / $426.58
| Professional | | $269.15 | $338.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $67.61
| Professional | 26 | $43.65 | $51.29 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $407.38
| Professional | | $144.54 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $67.61
| Professional | 26 | $22.91 | $43.65 | $67.61 |