- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $125.89 / $2,238.72
| Facility | 26 | $64.57 | $125.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $398.11 / $1,288.25
| Professional | | $77.62 | $398.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $128.82 / $363.08
| Professional | 26 | $64.57 | $128.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,584.89
| Professional | 50 | $1,096.48 | $1,096.48 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $100.00 / $102.33 / $501.19
| Professional | 52 | $100.00 | $102.33 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.25 / $281.84 / $616.60
| Professional | TC | $141.25 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $389.05 / $660.69
| Professional | | $208.93 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $74.13 / $120.23
| Professional | 26 | $45.71 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.25 / $295.12 / $575.44
| Professional | TC | $141.25 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $245.47
| Professional | | $204.17 | $204.17 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $81.28 / $676.08
| Professional | 26 | $63.10 | $81.28 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Professional | TC | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $398.11 / $741.31
| Professional | | $190.55 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $70.79 / $138.04
| Professional | 26 | $52.48 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $131.83 / $275.42 / $660.69
| Professional | TC | $131.83 | $275.42 | $660.69 |