- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $398.11
| Facility | 26 | $100.00 | $138.04 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $562.34
| Professional | | $223.87 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $354.81
| Professional | 26 | $97.72 | $134.90 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $239.88
| Professional | 26 | $97.72 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $457.09 / $758.58
| Professional | | $239.88 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $275.42
| Professional | 26 | $117.49 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $263.03
| Professional | | $104.71 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $645.65
| Professional | | $251.19 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $281.84
| Professional | 26 | $109.65 | $154.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $316.23 / $851.14
| Professional | | $245.47 | $316.23 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $331.13
| Professional | 26 | $107.15 | $144.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $177.83 / $660.69 / $851.14
| Professional | 53 | $177.83 | $660.69 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $257.04 / $602.56
| Professional | | $177.83 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $616.60
| Professional | | $234.42 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $257.04
| Professional | 26 | $104.71 | $138.04 | $257.04 |