- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $229.09
| Professional | | $97.72 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $100.00
| Professional | 26 | $39.81 | $54.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $239.88
| Professional | | $66.07 | $112.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $97.72
| Professional | 26 | $26.30 | $43.65 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $338.84
| Professional | | $117.49 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $97.72 / $138.04
| Professional | 26 | $47.86 | $97.72 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $234.42 / $407.38
| Professional | | $173.78 | $234.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $169.82
| Professional | 26 | $72.44 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $223.87
| Professional | | $102.33 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $239.88 / $380.19
| Professional | | $104.71 | $239.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $53.70 / $147.91
| Professional | 26 | $28.84 | $53.70 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $398.11
| Professional | | $177.83 | $269.15 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $162.18
| Professional | 26 | $75.86 | $112.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $389.05
| Professional | | $79.43 | $128.82 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $54.95 / $162.18
| Professional | 26 | $33.88 | $54.95 | $162.18 |