- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $501.19 / $794.33
| Facility | 26 | $257.04 | $501.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,023.29 / $3,311.31
| Professional | | $794.33 | $1,023.29 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,698.24 / $3,235.94
| Professional | | $1,288.25 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,412.54 / $3,162.28
| Professional | | $977.24 | $1,412.54 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,202.26 / $2,511.89
| Professional | | $812.83 | $1,202.26 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,230.27 / $1,659.59
| Professional | | $812.83 | $1,230.27 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $331.13 / $446.68
| Professional | 26 | $234.42 | $331.13 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,202.26 / $2,398.83
| Professional | | $891.25 | $1,202.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $398.11 / $794.33
| Professional | 26 | $288.40 | $398.11 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | 26 | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $7,762.47 / $7,762.47
| Professional | | $5,623.41 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $275.42 / $831.76
| Professional | | $32.36 | $275.42 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | 26 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,174.90 / $2,454.71
| Professional | | $794.33 | $1,174.90 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $3,019.95
| Professional | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,122.02 / $1,380.38
| Professional | | $812.83 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,148.15 / $2,511.89
| Professional | | $724.44 | $1,148.15 | $2,511.89 |