- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $120.23 / $323.59
| Facility | 26 | $74.13 | $120.23 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $2,238.72
| Professional | | $398.11 | $588.84 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $109.65 / $288.40
| Professional | 26 | $70.79 | $109.65 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $302.00 / $446.68 / $1,174.90
| Professional | TC | $302.00 | $446.68 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $1,047.13
| Professional | | $371.54 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $102.33 / $190.55
| Professional | 26 | $79.43 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $426.58 / $870.96
| Professional | TC | $288.40 | $426.58 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $114.82 / $338.84
| Facility | 26 | $19.95 | $114.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $1,348.96
| Professional | | $398.11 | $676.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $123.03 / $239.88
| Professional | 26 | $74.13 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $331.13 / $562.34 / $1,096.48
| Professional | TC | $331.13 | $562.34 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,047.13
| Professional | | $380.19 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $97.72 / $177.83
| Professional | 26 | $67.61 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $316.23 / $478.63 / $891.25
| Professional | TC | $316.23 | $478.63 | $891.25 |