- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $323.59
| Facility | 26 | $70.79 | $91.20 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $457.09 / $933.25
| Professional | | $199.53 | $457.09 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $117.49 / $234.42
| Professional | 26 | $67.61 | $117.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | 52 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $257.04 / $467.74
| Professional | TC | $114.82 | $257.04 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $398.11 / $676.08
| Professional | | $190.55 | $398.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $144.54
| Professional | 26 | $51.29 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $281.84 / $562.34
| Professional | TC | $123.03 | $281.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $295.12
| Professional | | $194.98 | $194.98 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $70.79 / $691.83
| Professional | 26 | $69.18 | $70.79 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $302.00 / $1,000.00
| Professional | | $79.43 | $302.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $354.81
| Professional | 26 | $61.66 | $95.50 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $338.84 / $645.65
| Professional | TC | $120.23 | $338.84 | $645.65 |