- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $645.65
| Facility | 26 | $117.49 | $117.49 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $309.03 / $602.56
| Professional | | $275.42 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | 26 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,122.02 / $1,412.54
| Professional | | $537.03 | $1,122.02 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $758.58 / $1,202.26
| Professional | | $416.87 | $758.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $269.15
| Professional | 26 | $109.65 | $162.18 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $870.96 / $1,096.48 / $1,096.48
| Facility | 26 | $870.96 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $724.44 / $2,137.96
| Professional | | $457.09 | $724.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $1,348.96
| Professional | | $575.44 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $281.84 / $323.59
| Professional | 26 | $234.42 | $281.84 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | 26 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $812.83 / $1,348.96
| Professional | | $707.95 | $812.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $645.65 / $1,230.27
| Professional | | $467.74 | $645.65 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $1,071.52
| Professional | | $912.01 | $912.01 | $1,071.52 |