- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $724.44
| Facility | 26 | $549.54 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,380.38 / $2,570.40
| Professional | | $1,047.13 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $467.74 / $1,621.81
| Professional | 26 | $338.84 | $467.74 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $371.54
| Professional | 26 | $331.13 | $331.13 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,348.96 / $8,511.38
| Professional | | $1,174.90 | $1,348.96 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $407.38 / $2,630.27
| Professional | 26 | $363.08 | $407.38 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,584.89 / $2,398.83
| Professional | | $1,288.25 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $478.63 / $707.95
| Professional | 26 | $380.19 | $478.63 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $3,388.44
| Facility | 26 | $2,691.53 | $2,691.53 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,479.11 / $8,317.64
| Professional | | $1,174.90 | $1,479.11 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $457.09 / $2,290.87
| Professional | 26 | $354.81 | $457.09 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,380.38 / $2,137.96
| Professional | | $1,096.48 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $426.58 / $660.69
| Professional | 26 | $338.84 | $426.58 | $660.69 |