- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $257.04
| Professional | | $141.25 | $165.96 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $194.98
| Professional | 26 | $61.66 | $72.44 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $181.97 / $302.00
| Professional | | $141.25 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $128.82
| Professional | 26 | $61.66 | $79.43 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $186.21 / $263.03
| Professional | | $138.04 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $112.20
| Professional | 26 | $60.26 | $81.28 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $158.49 / $245.47
| Professional | | $2.00 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.55 / $61.66 / $102.33
| Professional | 26 | $0.55 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $245.47
| Professional | | $2.00 | $2.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.55 / $0.55 / $102.33
| Professional | 26 | $0.55 | $0.55 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $165.96 / $281.84
| Professional | | $151.36 | $165.96 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $67.61 / $123.03
| Professional | 26 | $64.57 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $281.84
| Professional | | $107.15 | $169.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $125.89
| Professional | 26 | $58.88 | $75.86 | $125.89 |