- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.01 / $1,907.96 / $1,919.47
| Facility | 26 | $80.01 | $1,907.96 | $1,919.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.83 / $528.83 / $528.83
| Professional | | $528.83 | $528.83 | $528.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.74 / $80.01 / $157.83
| Professional | 26 | $62.74 | $80.01 | $157.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $448.82 / $448.82 / $448.82
| Professional | TC | $448.82 | $448.82 | $448.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.30 / $656.58 / $1,234.19
| Professional | | $512.30 | $656.58 | $1,234.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.19 / $101.00 / $190.77
| Professional | 26 | $79.19 | $101.00 | $190.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $433.12 / $559.67 / $1,043.42
| Professional | TC | $433.12 | $559.67 | $1,043.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.99 / $313.30 / $431.56
| Professional | | $32.99 | $313.30 | $431.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,376.81 / $2,376.81 / $2,376.81
| Facility | 26 | $2,376.81 | $2,376.81 | $2,376.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.91 / $922.41 / $997.69
| Professional | | $646.91 | $922.41 | $997.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.15 / $133.72 / $150.87
| Professional | 26 | $98.15 | $133.72 | $150.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $548.77 / $788.67 / $846.82
| Professional | TC | $548.77 | $788.67 | $846.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.34 / $502.86 / $844.20
| Professional | | $406.34 | $502.86 | $844.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.91 / $73.62 / $122.40
| Professional | 26 | $58.91 | $73.62 | $122.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $347.43 / $434.16 / $716.36
| Professional | TC | $347.43 | $434.16 | $716.36 |