- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $467.74 / $831.76
| Facility | 26 | $199.53 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $630.96 / $1,479.11
| Professional | | $478.63 | $630.96 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $223.87 / $501.19
| Professional | 26 | $165.96 | $223.87 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $676.08 / $1,122.02
| Professional | | $549.54 | $676.08 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $380.19
| Professional | 26 | $194.98 | $234.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $707.95 / $1,000.00
| Professional | | $616.60 | $707.95 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $223.87 / $338.84
| Professional | 26 | $213.80 | $223.87 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,148.15
| Professional | | $537.03 | $776.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $269.15 / $380.19
| Professional | 26 | $186.21 | $269.15 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $467.74 / $912.01 / $912.01
| Facility | 26 | $467.74 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $3,801.89
| Professional | | $524.81 | $724.44 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $239.88 / $1,230.27
| Professional | 26 | $173.78 | $239.88 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $1,122.02
| Professional | | $537.03 | $676.08 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $229.09 / $389.05
| Professional | 26 | $186.21 | $229.09 | $389.05 |