- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $407.38 / $575.44
| Facility | 26 | $389.05 | $407.38 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,348.96 / $3,019.95
| Professional | | $1,000.00 | $1,348.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $933.25
| Professional | 26 | $302.00 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $2,818.38
| Professional | | $1,148.15 | $1,621.81 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $707.95
| Professional | 26 | $363.08 | $436.52 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,148.15 / $1,548.82
| Professional | | $1,023.29 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $354.81 / $478.63
| Professional | 26 | $316.23 | $354.81 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,659.59 / $2,454.71
| Professional | | $1,096.48 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $741.31
| Professional | 26 | $323.59 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,398.83 / $3,019.95 / $3,019.95
| Facility | 26 | $2,398.83 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,862.09 / $7,413.10
| Professional | | $1,047.13 | $1,862.09 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $2,041.74
| Professional | 26 | $316.23 | $588.84 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,698.24 / $2,570.40
| Professional | | $1,096.48 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $524.81 / $794.33
| Professional | 26 | $323.59 | $524.81 | $794.33 |