- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $158.49 / $446.68
| Facility | 26 | $95.50 | $158.49 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $1,047.13
| Professional | | $346.74 | $457.09 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $128.82 / $363.08
| Professional | 26 | $89.13 | $128.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.19 / $338.84 / $707.95
| Professional | TC | $251.19 | $338.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $1,000.00
| Professional | | $371.54 | $524.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $123.03 / $239.88
| Professional | 26 | $93.33 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $398.11 / $776.25
| Professional | TC | $288.40 | $398.11 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $144.54 / $426.58
| Facility | 26 | $25.70 | $144.54 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $1,230.27
| Professional | | $389.05 | $616.60 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $158.49 / $302.00
| Professional | 26 | $97.72 | $158.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $295.12 / $467.74 / $912.01
| Professional | TC | $295.12 | $467.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $954.99
| Professional | | $371.54 | $549.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $131.83 / $229.09
| Professional | 26 | $87.10 | $131.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $281.84 / $416.87 / $741.31
| Professional | TC | $281.84 | $416.87 | $741.31 |