- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $64.57
| Facility | 26 | $34.67 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $134.90
| Professional | | $79.43 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $44.67
| Professional | 26 | $28.84 | $33.11 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $117.49 / $190.55
| Professional | | $56.23 | $117.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $72.44
| Professional | 26 | $33.88 | $47.86 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $35.48 / $51.29
| Facility | 26 | $7.59 | $35.48 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $190.55
| Professional | | $87.10 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $69.18
| Professional | 26 | $32.36 | $42.66 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $741.31
| Professional | | $562.34 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $245.47
| Professional | 26 | $199.53 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $165.96
| Professional | | $75.86 | $107.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $63.10
| Professional | 26 | $28.18 | $38.90 | $63.10 |