- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $66.07 / $112.20
| Facility | 26 | $38.90 | $66.07 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $87.10 / $204.17
| Professional | | $67.61 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $112.20
| Professional | 26 | $30.90 | $38.02 | $112.20 |
- 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
- $74.13 / $74.13 / $79.43
| Professional | | $74.13 | $74.13 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $165.96
| Professional | | $83.18 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $208.93
| Professional | | $67.61 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $53.70 / $87.10
| Professional | 26 | $27.54 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $177.83
| Professional | | $89.13 | $138.04 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $72.44
| Professional | 26 | $37.15 | $56.23 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $89.13 / $213.80
| Professional | | $69.18 | $89.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $91.20
| Professional | 26 | $30.20 | $38.02 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $181.97
| Professional | | $64.57 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $85.11
| Professional | 26 | $26.92 | $42.66 | $85.11 |