- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $1,698.24 / $1,698.24
| Facility | 26 | $63.10 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $208.93 / $645.65
| Professional | | $61.66 | $208.93 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $138.04 / $302.00
| Professional | 26 | $60.26 | $138.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $31.62 / $31.62 / $190.55
| Professional | 52 | $31.62 | $31.62 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.25 / $302.00 / $436.52
| Professional | TC | $141.25 | $302.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,548.82
| Professional | | $537.03 | $812.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $251.19 / $478.63
| Professional | 26 | $162.18 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $363.08 / $562.34 / $1,071.52
| Professional | TC | $363.08 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $1,000.00
| Professional | | $309.03 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $134.90 / $302.00
| Professional | 26 | $74.13 | $134.90 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $380.19 / $707.95
| Professional | TC | $218.78 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $1,479.11
| Professional | | $371.54 | $478.63 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $123.03 / $218.78
| Professional | 26 | $57.54 | $123.03 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $346.74 / $1,258.93
| Professional | TC | $263.03 | $346.74 | $1,258.93 |