- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $120.23
| Facility | 26 | $67.61 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $346.74
| Professional | | $141.25 | $165.96 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $257.04
| Professional | 26 | $61.66 | $75.86 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $154.88
| Professional | | $147.91 | $147.91 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $87.10
| Professional | 26 | $75.86 | $75.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $147.91 / $194.98
| Professional | | $125.89 | $147.91 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $93.33
| Professional | 26 | $61.66 | $72.44 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $100.00
| Professional | | $56.23 | $74.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $75.86 / $109.65
| Facility | 26 | $16.22 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $724.44
| Professional | | $141.25 | $208.93 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $331.13
| Professional | 26 | $64.57 | $97.72 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $131.83
| Professional | | $32.36 | $33.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $162.18 / $281.84
| Professional | | $131.83 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $125.89
| Professional | 26 | $60.26 | $74.13 | $125.89 |