- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $208.93
| Facility | 26 | $112.20 | $151.36 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $501.19
| Professional | | $229.09 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $331.13
| Professional | 26 | $97.72 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $141.25
| Professional | 26 | $95.50 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $416.87
| Professional | | $229.09 | $269.15 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $112.20 / $158.49
| Professional | 26 | $95.50 | $112.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $269.15
| Professional | | $104.71 | $138.04 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $120.23 / $169.82
| Facility | 26 | $25.70 | $120.23 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $72.44
| Facility | 53 | $33.88 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $398.11 / $1,148.15
| Professional | | $245.47 | $398.11 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $537.03
| Professional | 26 | $107.15 | $169.82 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $109.65
| Professional | | $32.36 | $33.11 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $501.19
| Professional | | $223.87 | $323.59 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $213.80
| Professional | 26 | $95.50 | $131.83 | $213.80 |