- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $154.88 / $389.05
| Facility | 26 | $85.11 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $2,041.74
| Professional | | $707.95 | $891.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $100.00 / $346.74
| Professional | 26 | $77.62 | $100.00 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $630.96 / $776.25 / $1,659.59
| Professional | TC | $630.96 | $776.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $2,398.83
| Professional | | $758.58 | $1,071.52 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $123.03 / $257.04
| Professional | 26 | $83.18 | $123.03 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $676.08 / $954.99 / $2,137.96
| Professional | TC | $676.08 | $954.99 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $134.90 / $416.87
| Facility | 26 | $23.44 | $134.90 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,348.96 / $2,454.71
| Professional | | $758.58 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $147.91 / $281.84
| Professional | 26 | $81.28 | $147.91 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $691.83 / $1,202.26 / $2,187.76
| Professional | TC | $691.83 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $2,041.74
| Professional | | $758.58 | $1,023.29 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $114.82 / $223.87
| Professional | 26 | $83.18 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $676.08 / $912.01 / $1,819.70
| Professional | TC | $676.08 | $912.01 | $1,819.70 |