- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $158.49 / $416.87
| Facility | 26 | $89.13 | $158.49 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $977.24
| Professional | | $275.42 | $446.68 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $138.04 / $331.13
| Professional | 26 | $83.18 | $138.04 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $302.00 / $588.84
| Professional | TC | $190.55 | $302.00 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Facility | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $954.99
| Professional | | $281.84 | $446.68 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $112.20 / $204.17
| Professional | 26 | $83.18 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.17 / $331.13 / $794.33
| Professional | TC | $204.17 | $331.13 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $109.65 / $269.15
| Facility | 26 | $20.89 | $109.65 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $537.03 / $1,000.00
| Professional | | $263.03 | $537.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $120.23 / $239.88
| Professional | 26 | $69.18 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $186.21 / $380.19 / $794.33
| Professional | TC | $186.21 | $380.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $446.68 / $831.76
| Professional | | $269.15 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $95.50 / $186.21
| Professional | 26 | $72.44 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $316.23 / $660.69
| Professional | TC | $190.55 | $316.23 | $660.69 |