- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $912.01 / $1,737.80 / $2,187.76
| Facility | 26 | $912.01 | $1,737.80 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $891.25 / $2,238.72
| Professional | | $660.69 | $891.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $537.03 / $1,174.90
| Professional | 26 | $380.19 | $537.03 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,000.00 / $7,079.46
| Professional | | $977.24 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $501.19 / $3,467.37
| Professional | 26 | $478.63 | $501.19 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,584.89
| Professional | | $758.58 | $1,023.29 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $616.60 / $954.99
| Professional | 26 | $457.09 | $616.60 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3,388.44 / $4,365.16 / $4,365.16
| Facility | 26 | $3,388.44 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,096.48 / $6,309.57
| Professional | | $891.25 | $1,096.48 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $5,011.87
| Professional | 26 | $524.81 | $660.69 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,047.13 / $1,479.11
| Professional | | $891.25 | $1,047.13 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $891.25
| Professional | 26 | $512.86 | $645.65 | $891.25 |