- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $389.05 / $630.96
| Facility | 26 | $363.08 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,380.38 / $2,630.27
| Professional | | $1,230.27 | $1,380.38 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $549.54 / $1,071.52
| Professional | 26 | $338.84 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $660.69 / $741.31
| Professional | 26 | $616.60 | $660.69 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $851.14 / $1,148.15
| Professional | | $537.03 | $851.14 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Professional | 26 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,862.09 / $3,235.94
| Professional | | $1,412.54 | $1,862.09 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $562.34 / $977.24
| Professional | 26 | $426.58 | $562.34 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,698.24 / $3,162.28
| Professional | | $1,202.26 | $1,698.24 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $537.03 / $977.24
| Professional | 26 | $371.54 | $537.03 | $977.24 |
- 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 |