- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $97.72 / $269.15
| Facility | 26 | $64.57 | $97.72 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $1,905.46
| Professional | | $371.54 | $537.03 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $85.11 / $234.42
| Professional | 26 | $66.07 | $85.11 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $407.38 / $870.96
| Professional | TC | $288.40 | $407.38 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $549.54 / $1,071.52
| Professional | | $398.11 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $97.72 / $181.97
| Professional | 26 | $74.13 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $331.13 / $457.09 / $891.25
| Professional | TC | $331.13 | $457.09 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $104.71 / $323.59
| Facility | 26 | $18.20 | $104.71 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $1,258.93
| Professional | | $389.05 | $676.08 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $117.49 / $218.78
| Professional | 26 | $66.07 | $117.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $323.59 / $575.44 / $1,047.13
| Professional | TC | $323.59 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,122.02
| Professional | | $407.38 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $100.00 / $190.55
| Professional | 26 | $67.61 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $338.84 / $478.63 / $912.01
| Professional | TC | $338.84 | $478.63 | $912.01 |