- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $45.71 / $58.88
| Facility | 26 | $21.88 | $45.71 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $102.33
| Professional | | $61.66 | $75.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $22.91 / $30.90
| Professional | 26 | $19.95 | $22.91 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Professional | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $91.20 / $147.91
| Professional | | $44.67 | $91.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $33.88 / $52.48
| Professional | 26 | $24.55 | $33.88 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $24.55 / $34.67
| Facility | 26 | $5.25 | $24.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $89.13 / $147.91
| Professional | | $69.18 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $29.51 / $47.86
| Professional | 26 | $22.91 | $29.51 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | 26 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $549.54
| Professional | | $436.52 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $165.96
| Professional | 26 | $141.25 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $134.90
| Professional | | $61.66 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $44.67
| Professional | 26 | $19.95 | $27.54 | $44.67 |