- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $128.82 / $371.54
| Facility | 26 | $79.43 | $128.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $1,288.25
| Professional | | $251.19 | $478.63 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $141.25 / $354.81
| Professional | 26 | $77.62 | $141.25 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.47 / $338.84 / $691.83
| Professional | TC | $245.47 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | 26 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $977.24
| Professional | | $316.23 | $467.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $91.20 / $181.97
| Professional | 26 | $69.18 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $363.08 / $851.14
| Professional | TC | $257.04 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $100.00 / $245.47
| Facility | 26 | $18.62 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $575.44 / $1,047.13
| Professional | | $302.00 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $109.65 / $218.78
| Professional | 26 | $61.66 | $109.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $446.68 / $851.14
| Professional | TC | $234.42 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $870.96
| Professional | | $309.03 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $87.10 / $169.82
| Professional | 26 | $66.07 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $371.54 / $707.95
| Professional | TC | $239.88 | $371.54 | $707.95 |