- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $229.09
| Facility | 26 | $114.82 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $630.96
| Professional | | $218.78 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $346.74
| Professional | 26 | $97.72 | $144.54 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $676.08
| Facility | 26 | $234.42 | $257.04 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | 53 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $389.05 / $1,905.46
| Professional | | $229.09 | $389.05 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $162.18 / $1,023.29
| Professional | 26 | $102.33 | $162.18 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $269.15
| Professional | 26 | $120.23 | $177.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $724.44
| Professional | | $251.19 | $398.11 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $309.03
| Professional | 26 | $109.65 | $165.96 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $154.88 / $354.81
| Professional | | $67.61 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $426.58 / $691.83
| Professional | | $245.47 | $426.58 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $281.84
| Professional | 26 | $107.15 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $194.98 / $218.78
| Professional | | $181.97 | $194.98 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $676.08
| Facility | 26 | $234.42 | $257.04 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | 53 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $389.05 / $1,905.46
| Professional | | $229.09 | $389.05 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $162.18 / $1,023.29
| Professional | 26 | $102.33 | $162.18 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $794.33
| Professional | | $251.19 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $165.96 / $331.13
| Professional | 26 | $112.20 | $165.96 | $331.13 |