- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $218.78 / $457.09
| Facility | 26 | $102.33 | $218.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $588.84
| Professional | | $223.87 | $316.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $537.03
| Professional | 26 | $97.72 | $144.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $524.81 / $812.83
| Professional | | $309.03 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $223.87 / $302.00
| Professional | 26 | $120.23 | $223.87 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $602.56 / $1,096.48
| Professional | | $234.42 | $602.56 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $346.74
| Professional | 26 | $107.15 | $223.87 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | 26 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 53 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $489.78 / $1,905.46
| Professional | | $257.04 | $489.78 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $1,023.29
| Professional | 26 | $114.82 | $186.21 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $660.69
| Professional | | $478.63 | $602.56 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $263.03 / $288.40
| Professional | 26 | $218.78 | $263.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $616.60 / $660.69
| Professional | | $575.44 | $616.60 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $288.40
| Professional | 26 | $194.98 | $269.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $229.09 / $478.63
| Professional | | $109.65 | $229.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $707.95
| Professional | | $245.47 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $309.03
| Professional | 26 | $112.20 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $549.54
| Professional | | $467.74 | $467.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $245.47
| Professional | 26 | $208.93 | $208.93 | $245.47 |