- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $35.48 / $75.86
| Facility | 26 | $19.50 | $35.48 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $275.42
| Professional | | $89.13 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $52.48
| Professional | 26 | $18.20 | $22.91 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $275.42
| Professional | | $83.18 | $104.71 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $48.98
| Professional | 26 | $19.05 | $23.99 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $158.49 / $190.55
| Professional | | $33.11 | $158.49 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $26.30 / $37.15
| Facility | 26 | $5.62 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $537.03
| Professional | | $100.00 | $165.96 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $33.88 / $83.18
| Professional | 26 | $18.20 | $33.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $275.42
| Professional | | $138.04 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $100.00
| Professional | 26 | $22.91 | $33.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $169.82 / $316.23
| Professional | | $75.86 | $169.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $54.95
| Professional | 26 | $19.05 | $30.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $173.78 / $354.81
| Professional | | $147.91 | $173.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $61.66
| Professional | 26 | $27.54 | $33.11 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $512.86
| Professional | | $109.65 | $177.83 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $30.20 / $100.00
| Professional | 26 | $19.95 | $30.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $79.43
| Facility | 26 | $19.05 | $26.92 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $169.82 / $316.23
| Professional | | $75.86 | $169.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $67.61
| Professional | 26 | $19.05 | $30.20 | $67.61 |