- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $19.05 / $30.90
| Facility | 26 | $16.22 | $19.05 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $263.03
| Professional | | $100.00 | $134.90 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $109.65 / $144.54
| Professional | | $28.18 | $109.65 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $27.54 / $39.81
| Facility | 26 | $5.89 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $114.82 / $223.87
| Professional | | $58.88 | $114.82 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 26 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,122.02 / $1,122.02
| Professional | | $891.25 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $22.91 / $32.36
| Facility | 26 | $16.22 | $22.91 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $295.12
| Professional | | $102.33 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $33.11 / $112.20
| Professional | | $19.50 | $33.11 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $380.19
| Professional | | $125.89 | $239.88 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $28.18 / $39.81
| Facility | 26 | $6.03 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $114.82 / $263.03
| Professional | | $57.54 | $114.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $380.19
| Professional | | $69.18 | $125.89 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $134.90 / $158.49
| Professional | | $128.82 | $134.90 | $158.49 |