- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $1,318.26 / $1,905.46
| Facility | 26 | $457.09 | $1,318.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $954.99 / $2,290.87
| Professional | | $741.31 | $954.99 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $512.86 / $1,737.80
| Professional | 26 | $380.19 | $512.86 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $977.24 / $1,659.59
| Professional | | $794.33 | $977.24 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $562.34 / $1,071.52
| Professional | 26 | $446.68 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,023.29 / $1,548.82
| Professional | | $954.99 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $549.54 / $812.83
| Professional | 26 | $489.78 | $549.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,071.52 / $1,698.24
| Professional | | $831.76 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $660.69 / $1,000.00
| Professional | 26 | $436.52 | $660.69 | $1,000.00 |
- 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
- $758.58 / $1,047.13 / $6,309.57
| Professional | | $758.58 | $1,047.13 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $630.96 / $5,011.87
| Professional | 26 | $407.38 | $630.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $977.24 / $1,659.59
| Professional | | $776.25 | $977.24 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $891.25
| Professional | 26 | $426.58 | $575.44 | $891.25 |