- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $630.96
| Facility | 26 | $338.84 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,258.93 / $2,137.96
| Professional | | $1,071.52 | $1,258.93 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $912.01
| Professional | 26 | $302.00 | $416.87 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $549.54 / $645.65
| Professional | 26 | $281.84 | $549.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $3,981.07 / $11,748.98
| Professional | | $1,348.96 | $3,981.07 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $489.78 / $758.58
| Professional | 26 | $380.19 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,659.59 / $2,398.83
| Professional | | $1,258.93 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $501.19 / $724.44
| Professional | 26 | $363.08 | $501.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | 26 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $9,120.11 / $9,120.11
| Professional | | $7,413.10 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,041.74 / $2,754.23 / $2,754.23
| Professional | 26 | $2,041.74 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $2,511.89
| Professional | | $1,071.52 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $489.78 / $758.58
| Professional | 26 | $323.59 | $489.78 | $758.58 |