- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $54.95 / $138.04
| Facility | 26 | $36.31 | $54.95 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $1,148.15
| Professional | | $331.13 | $436.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $60.26 / $151.36
| Professional | 26 | $35.48 | $60.26 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $295.12 / $398.11 / $741.31
| Professional | TC | $295.12 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $977.24
| Professional | | $338.84 | $501.19 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $52.48 / $100.00
| Professional | 26 | $38.90 | $52.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $316.23 / $446.68 / $870.96
| Professional | TC | $316.23 | $446.68 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $57.54 / $181.97
| Facility | 26 | $10.23 | $57.54 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $660.69 / $1,202.26
| Professional | | $354.81 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $64.57 / $123.03
| Professional | 26 | $36.31 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $323.59 / $588.84 / $1,071.52
| Professional | TC | $323.59 | $588.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $1,000.00
| Professional | | $371.54 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $50.12 / $97.72
| Professional | 26 | $36.31 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $338.84 / $457.09 / $891.25
| Professional | TC | $338.84 | $457.09 | $891.25 |