- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $524.81
| Facility | 26 | $77.62 | $77.62 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $1,023.29
| Professional | | $144.54 | $245.47 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $123.03 / $338.84
| Professional | 26 | $77.62 | $123.03 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $302.00
| Professional | | $128.82 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $162.18
| Professional | 26 | $70.79 | $95.50 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $204.17 / $354.81
| Professional | | $81.28 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $213.80
| Professional | 26 | $87.10 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $234.42 / $380.19
| Professional | | $151.36 | $234.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $194.98
| Professional | 26 | $81.28 | $114.82 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | 26 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,513.56
| Professional | | $1,479.11 | $1,479.11 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $630.96 / $707.95 / $707.95
| Professional | 26 | $630.96 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $338.84
| Professional | | $162.18 | $213.80 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $181.97
| Professional | 26 | $87.10 | $109.65 | $181.97 |