- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $41.69 / $41.69
| Facility | 26 | $18.20 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $144.54 / $346.74
| Professional | | $63.10 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $42.66 / $100.00
| Professional | 26 | $18.20 | $42.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $162.18
| Professional | | $151.36 | $151.36 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $46.77
| Professional | 26 | $21.88 | $21.88 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $158.49
| Professional | | $69.18 | $114.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $39.81
| Professional | 26 | $17.78 | $29.51 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $199.53
| Professional | | $112.20 | $158.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $50.12
| Professional | 26 | $33.11 | $39.81 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $100.00 / $100.00
| Facility | 26 | $44.67 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $141.25 / $512.86
| Professional | | $66.07 | $141.25 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $123.03
| Professional | 26 | $22.39 | $37.15 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $151.36 / $190.55
| Professional | | $147.91 | $151.36 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $51.29
| Professional | 26 | $38.02 | $40.74 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $165.96 / $177.83
| Professional | | $147.91 | $165.96 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $43.65 / $47.86
| Professional | 26 | $38.02 | $43.65 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $190.55
| Professional | | $69.18 | $128.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $51.29
| Professional | 26 | $22.39 | $35.48 | $51.29 |