- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $44.67 / $56.23
| Facility | 26 | $37.15 | $44.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $234.42
| Professional | | $70.79 | $93.33 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $120.23
| Professional | 26 | $38.02 | $51.29 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $40.74 / $47.86
| Professional | 26 | $37.15 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $77.62 / $123.03
| Professional | | $42.66 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $181.97
| Professional | | $87.10 | $114.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $95.50
| Professional | 26 | $47.86 | $63.10 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 26 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $758.58 / $758.58
| Professional | | $616.60 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $407.38 / $407.38
| Professional | 26 | $316.23 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $69.18
| Facility | 26 | $39.81 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $134.90 / $190.55
| Professional | | $75.86 | $134.90 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $95.50
| Professional | 26 | $39.81 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $38.90
| Professional | | $32.36 | $33.11 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $177.83 / $213.80
| Professional | | $10.00 | $177.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $173.78
| Professional | | $89.13 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $93.33
| Professional | 26 | $47.86 | $63.10 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $151.36
| Professional | | $69.18 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $81.28
| Professional | 26 | $38.02 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $107.15 / $107.15
| Professional | | $100.00 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $52.48 / $52.48
| Professional | 26 | $47.86 | $52.48 | $52.48 |