- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $44.67 / $87.10
| Facility | 26 | $36.31 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $87.10 / $194.98
| Professional | | $74.13 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $38.02 / $93.33
| Professional | 26 | $33.11 | $38.02 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | 50 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $134.90
| Professional | | $61.66 | $81.28 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $61.66
| Professional | 26 | $30.90 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $141.25
| Professional | | $87.10 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $63.10
| Professional | 26 | $38.02 | $44.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $169.82
| Professional | | $77.62 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $81.28
| Professional | 26 | $35.48 | $48.98 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $165.96 / $165.96
| Facility | 26 | $85.11 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $549.54
| Professional | | $75.86 | $107.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $234.42
| Professional | 26 | $35.48 | $50.12 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $162.18
| Professional | | $72.44 | $95.50 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $75.86
| Professional | 26 | $33.11 | $44.67 | $75.86 |