- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $501.19 / $645.65
| Facility | 26 | $309.03 | $501.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,258.93 / $2,454.71
| Professional | | $1,122.02 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $380.19 / $707.95
| Professional | 26 | $309.03 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,380.38 / $1,949.84
| Professional | | $1,047.13 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $407.38 / $575.44
| Professional | 26 | $309.03 | $407.38 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,621.81 / $10,471.29
| Professional | | $354.81 | $1,621.81 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $549.54
| Professional | 26 | $323.59 | $323.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,548.82 / $2,818.38
| Professional | | $1,202.26 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $831.76
| Professional | 26 | $346.74 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,288.25 / $1,584.89
| Professional | | $1,071.52 | $1,288.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $371.54 / $467.74
| Professional | 26 | $309.03 | $371.54 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,862.09 / $2,290.87
| Professional | | $1,479.11 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $616.60
| Professional | 26 | $489.78 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,258.93 / $11,748.98
| Professional | | $416.87 | $1,258.93 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $436.52 / $758.58
| Professional | 26 | $346.74 | $436.52 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,621.81 / $2,511.89
| Professional | | $1,071.52 | $1,621.81 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $478.63 / $707.95
| Professional | 26 | $295.12 | $478.63 | $707.95 |