- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $251.19 / $302.00 / $407.38
| Facility | 26 | $251.19 | $302.00 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $1,000.00
| Professional | | $281.84 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $302.00
| Professional | 26 | $83.18 | $134.90 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | 26 | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $630.96
| Professional | | $316.23 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $165.96
| Professional | 26 | $83.18 | $104.71 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $95.50 / $138.04
| Facility | 26 | $20.42 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $416.87 / $851.14
| Professional | | $229.09 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $186.21
| Professional | 26 | $66.07 | $104.71 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $794.33
| Facility | 26 | $616.60 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $501.19 / $3,467.37
| Professional | | $269.15 | $501.19 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $707.95
| Professional | 26 | $77.62 | $93.33 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $398.11 / $660.69
| Professional | | $269.15 | $398.11 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $85.11 / $154.88
| Professional | 26 | $77.62 | $85.11 | $154.88 |