- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $194.98
| Facility | 26 | $56.23 | $56.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $199.53 / $323.59
| Professional | | $169.82 | $199.53 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $302.00 / $707.95
| Professional | | $199.53 | $302.00 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $257.04
| Facility | 26 | $138.04 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $489.78 / $676.08
| Professional | | $239.88 | $489.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $380.19 / $512.86
| Professional | | $323.59 | $380.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $380.19 / $1,318.26
| Professional | | $169.82 | $380.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $151.36
| Professional | | $32.36 | $33.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $288.40 / $501.19
| Professional | | $134.90 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $467.74 / $645.65
| Professional | | $257.04 | $467.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $331.13 / $331.13
| Facility | 26 | $123.03 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,023.29 / $1,318.26
| Professional | | $229.09 | $1,023.29 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Professional | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $724.44 / $1,071.52
| Professional | | $446.68 | $724.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $707.95
| Professional | | $186.21 | $338.84 | $707.95 |