- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $173.78 / $213.80
| Professional | | $41.69 | $173.78 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $100.00 / $158.49
| Facility | 26 | $85.11 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $524.81 / $602.56
| Professional | | $208.93 | $524.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $93.33 / $107.15
| Professional | 26 | $36.31 | $93.33 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $389.05 / $501.19
| Professional | | $331.13 | $389.05 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $89.13
| Professional | 26 | $58.88 | $70.79 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $1,148.15
| Professional | | $89.13 | $169.82 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $61.66 / $194.98
| Professional | 26 | $33.88 | $61.66 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $302.00 / $575.44
| Professional | | $60.26 | $302.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $83.18 / $138.04
| Professional | 26 | $34.67 | $83.18 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $194.98
| Facility | 26 | $60.26 | $60.26 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,148.15 / $1,148.15
| Professional | | $741.31 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $194.98 / $194.98
| Professional | 26 | $158.49 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $218.78 / $645.65
| Professional | | $177.83 | $218.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $60.26 / $177.83
| Professional | 26 | $50.12 | $60.26 | $177.83 |