- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $489.78 / $1,905.46
| Facility | 26 | $363.08 | $489.78 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,445.44 / $3,981.07
| Professional | | $1,202.26 | $1,445.44 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $524.81 / $1,659.59
| Professional | 26 | $354.81 | $524.81 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $776.25
| Professional | 26 | $288.40 | $288.40 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,754.23 / $5,370.32
| Professional | | $1,862.09 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $537.03 / $794.33 / $1,479.11
| Professional | 26 | $537.03 | $794.33 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,778.28 / $4,168.69
| Professional | | $1,174.90 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $489.78 / $1,148.15
| Professional | 26 | $331.13 | $489.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,737.80 / $4,073.80
| Professional | | $1,348.96 | $1,737.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $501.19 / $1,122.02
| Professional | 26 | $398.11 | $501.19 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,412.54 / $2,041.74
| Professional | | $1,122.02 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $398.11 / $512.86
| Professional | 26 | $323.59 | $398.11 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,584.89 / $2,754.23
| Professional | | $1,230.27 | $1,584.89 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $489.78 / $954.99
| Professional | 26 | $354.81 | $489.78 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 26 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $10,000.00 / $10,000.00
| Professional | | $8,317.64 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,290.87 / $3,090.30 / $3,090.30
| Professional | 26 | $2,290.87 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,148.15 / $1,698.24
| Professional | | $537.03 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | 26 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,737.80 / $3,890.45
| Professional | | $1,348.96 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $1,122.02
| Professional | 26 | $398.11 | $489.78 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Professional | 26 | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,698.24 / $2,398.83
| Professional | | $1,288.25 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,584.89 / $3,630.78
| Professional | | $1,071.52 | $1,584.89 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $1,000.00
| Professional | 26 | $316.23 | $478.63 | $1,000.00 |