- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $616.60
| Facility | 26 | $489.78 | $489.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,445.44 / $2,137.96
| Professional | | $1,202.26 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $489.78 / $1,047.13
| Professional | 26 | $346.74 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $512.86 / $707.95
| Professional | 26 | $380.19 | $512.86 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,778.28 / $1,778.28
| Professional | | $1,230.27 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $933.25
| Professional | 26 | $575.44 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,737.80 / $2,290.87
| Professional | | $1,096.48 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $676.08
| Professional | 26 | $331.13 | $537.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $501.19 / $1,230.27
| Facility | 26 | $489.78 | $501.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,584.89 / $2,290.87
| Professional | | $1,230.27 | $1,584.89 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $489.78 / $870.96
| Professional | 26 | $363.08 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,698.24 / $2,137.96
| Professional | | $851.14 | $1,698.24 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $537.03 / $676.08
| Professional | 26 | $269.15 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,621.81 / $2,137.96
| Professional | | $1,288.25 | $1,621.81 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $707.95
| Professional | 26 | $407.38 | $524.81 | $707.95 |