- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $154.88 / $416.87
| Facility | 26 | $107.15 | $154.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $2,398.83
| Professional | | $346.74 | $524.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $162.18 / $478.63
| Professional | 26 | $97.72 | $162.18 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $354.81 / $1,023.29
| Professional | TC | $239.88 | $354.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Facility | 26 | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $549.54 / $1,479.11
| Professional | | $346.74 | $549.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $125.89 / $251.19
| Professional | 26 | $97.72 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $407.38 / $1,230.27
| Professional | TC | $257.04 | $407.38 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $134.90 / $331.13
| Facility | 26 | $25.70 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,445.44
| Professional | | $346.74 | $707.95 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $147.91 / $288.40
| Professional | 26 | $85.11 | $147.91 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $501.19 / $1,174.90
| Professional | TC | $239.88 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $1,202.26
| Professional | | $338.84 | $575.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $117.49 / $229.09
| Professional | 26 | $89.13 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $416.87 / $1,000.00
| Professional | TC | $239.88 | $416.87 | $1,000.00 |