- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $549.54
| Facility | 26 | $457.09 | $457.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $912.01 / $2,344.23
| Professional | | $660.69 | $912.01 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $549.54 / $1,047.13
| Professional | 26 | $426.58 | $549.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $831.76 / $1,445.44
| Professional | | $758.58 | $831.76 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $426.58 / $724.44
| Professional | 26 | $416.87 | $426.58 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $1,737.80
| Professional | | $724.44 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $645.65 / $891.25
| Professional | 26 | $478.63 | $645.65 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $1,122.02 / $1,548.82
| Professional | | $6.46 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $549.54 / $794.33
| Professional | 26 | $5.25 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $1,380.38
| Professional | | $6.46 | $6.46 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $691.83
| Professional | 26 | $5.25 | $5.25 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $933.25 / $933.25
| Professional | | $891.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $457.09 / $457.09
| Professional | 26 | $446.68 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $977.24 / $1,584.89
| Professional | | $36.31 | $977.24 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $933.25
| Professional | 26 | $398.11 | $588.84 | $933.25 |