- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $524.81
| Facility | 26 | $229.09 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,318.26 / $2,290.87
| Professional | | $977.24 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $724.44
| Professional | 26 | $295.12 | $380.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $389.05 / $457.09
| Professional | 26 | $346.74 | $389.05 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $870.96 / $1,445.44
| Professional | | $295.12 | $870.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,737.80 / $1,905.46
| Professional | | $1,698.24 | $1,737.80 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $501.19
| Professional | 26 | $354.81 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,659.59 / $2,398.83
| Professional | | $1,288.25 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $501.19 / $758.58
| Professional | 26 | $380.19 | $501.19 | $758.58 |
- 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
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $467.74
| Facility | 26 | $229.09 | $316.23 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,621.81 / $3,019.95
| Professional | | $1,023.29 | $1,621.81 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $467.74 / $794.33
| Professional | 26 | $295.12 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $870.96
| Professional | | $32.36 | $33.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $3,090.30 / $4,466.84
| Professional | | $1,318.26 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,698.24 / $2,398.83
| Professional | | $1,230.27 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $501.19 / $741.31
| Professional | 26 | $380.19 | $501.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,380.38 / $2,187.76
| Professional | | $1,047.13 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $426.58 / $660.69
| Professional | 26 | $316.23 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,230.27
| Professional | | $1,148.15 | $1,148.15 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $380.19
| Professional | 26 | $354.81 | $354.81 | $380.19 |