- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $79.43 / $125.89
| Facility | 26 | $70.79 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $1,778.28
| Professional | | $194.98 | $426.58 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $141.25 / $154.88
| Professional | 26 | $64.57 | $141.25 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $239.88 / $436.52
| Professional | TC | $123.03 | $239.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $169.82 / $407.38
| Professional | | $91.20 | $169.82 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $114.82
| Facility | 26 | $16.98 | $79.43 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $489.78 / $2,398.83
| Professional | | $158.49 | $489.78 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $380.19
| Professional | 26 | $56.23 | $100.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $302.00 / $1,479.11
| Professional | TC | $100.00 | $302.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $120.23 / $190.55
| Professional | 26 | $112.20 | $120.23 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $363.08 / $870.96
| Professional | | $173.78 | $363.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $151.36
| Professional | 26 | $44.67 | $85.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $251.19 / $741.31
| Professional | TC | $107.15 | $251.19 | $741.31 |