- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $91.20 / $100.00
| Facility | 26 | $53.70 | $91.20 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $363.08 / $812.83
| Professional | | $309.03 | $363.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $158.49
| Professional | 26 | $51.29 | $66.07 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $354.81 / $354.81
| Professional | | $338.84 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $83.18
| Professional | 26 | $57.54 | $66.07 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $199.53 / $537.03
| Professional | | $61.66 | $199.53 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $446.68 / $707.95
| Professional | | $239.88 | $446.68 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $123.03
| Professional | 26 | $54.95 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $489.78 / $812.83
| Professional | | $281.84 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $199.53
| Professional | 26 | $56.23 | $87.10 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $416.87 / $446.68
| Professional | | $407.38 | $416.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $69.18 / $72.44
| Professional | 26 | $67.61 | $69.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $36.31
| Professional | | $32.36 | $33.11 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $676.08
| Professional | | $263.03 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $128.82
| Professional | 26 | $53.70 | $79.43 | $128.82 |