- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $575.44 / $870.96
| Facility | 26 | $239.88 | $575.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $602.56 / $1,071.52
| Professional | | $489.78 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $199.53 / $512.86
| Professional | 26 | $169.82 | $199.53 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $213.80 / $354.81
| Professional | 26 | $199.53 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $724.44 / $1,071.52
| Professional | | $588.84 | $724.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $363.08
| Professional | 26 | $199.53 | $251.19 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $724.44 / $1,122.02
| Professional | | $501.19 | $724.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $389.05
| Professional | 26 | $162.18 | $245.47 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $1,047.13
| Professional | | $794.33 | $794.33 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $323.59
| Professional | 26 | $263.03 | $263.03 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $741.31 / $1,000.00
| Professional | | $457.09 | $741.31 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $338.84
| Professional | 26 | $154.88 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $245.47 / $363.08
| Professional | 26 | $213.80 | $245.47 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $213.80 / $269.15
| Professional | 26 | $199.53 | $213.80 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $645.65
| Facility | 26 | $194.98 | $371.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $1,348.96
| Professional | | $512.86 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $208.93 / $426.58
| Professional | 26 | $173.78 | $208.93 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,096.48 / $1,174.90
| Professional | | $263.03 | $1,096.48 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $213.80
| Facility | 26 | $194.98 | $194.98 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $549.54 / $616.60
| Professional | | $316.23 | $549.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $213.80
| Professional | 26 | $194.98 | $194.98 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $676.08 / $1,096.48
| Professional | | $524.81 | $676.08 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $229.09 / $371.54
| Professional | 26 | $177.83 | $229.09 | $371.54 |