- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $177.83 / $426.58
| Facility | 26 | $95.50 | $177.83 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $1,737.80
| Professional | | $346.74 | $501.19 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $138.04 / $295.12
| Professional | 26 | $85.11 | $138.04 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $346.74 / $691.83
| Professional | TC | $257.04 | $346.74 | $691.83 |
- 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
- $338.84 / $512.86 / $1,000.00
| Professional | | $338.84 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $112.20 / $208.93
| Professional | 26 | $81.28 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $398.11 / $812.83
| Professional | TC | $263.03 | $398.11 | $812.83 |
- 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
- $323.59 / $575.44 / $1,071.52
| Professional | | $323.59 | $575.44 | $1,071.52 |
- 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
- $251.19 / $457.09 / $851.14
| Professional | TC | $251.19 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $870.96
| Professional | | $323.59 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $93.33 / $181.97
| Professional | 26 | $70.79 | $93.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.47 / $371.54 / $691.83
| Professional | TC | $245.47 | $371.54 | $691.83 |