- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $354.81
| Facility | 26 | $331.13 | $331.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,288.25 / $2,137.96
| Professional | | $1,071.52 | $1,288.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $389.05 / $1,122.02
| Professional | 26 | $302.00 | $389.05 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $263.03 / $263.03
| Facility | 26 | $218.78 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,290.87 / $3,890.45
| Professional | | $1,548.82 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $707.95 / $1,174.90
| Professional | 26 | $478.63 | $707.95 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $2,691.53
| Facility | 26 | $794.33 | $1,122.02 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,311.31 / $4,570.88
| Professional | | $2,238.72 | $3,311.31 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $630.96 / $933.25 / $1,288.25
| Professional | 26 | $630.96 | $933.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $870.96 / $1,071.52 / $2,137.96
| Facility | 26 | $870.96 | $1,071.52 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,884.03 / $4,365.16
| Professional | | $2,041.74 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $575.44 / $812.83 / $1,202.26
| Professional | 26 | $575.44 | $812.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $4,265.80
| Professional | | $1,412.54 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $645.65 / $1,202.26
| Professional | 26 | $407.38 | $645.65 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,454.71 / $4,168.69
| Professional | | $1,412.54 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $676.08 / $1,202.26
| Professional | 26 | $416.87 | $676.08 | $1,202.26 |