- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.77 / $138.04 / $234.42
| Facility | 26 | $46.77 | $138.04 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $501.19 / $1,023.29
| Professional | | $389.05 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $47.86 / $141.25
| Professional | 26 | $37.15 | $47.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $354.81 / $446.68 / $954.99
| Professional | TC | $354.81 | $446.68 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $436.52 / $1,258.93
| Professional | | $257.04 | $436.52 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.55 / $43.65 / $123.03
| Professional | 26 | $24.55 | $43.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $389.05 / $1,122.02
| Professional | TC | $234.42 | $389.05 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $74.13 / $109.65
| Facility | 26 | $13.80 | $74.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $501.19 / $1,047.13
| Professional | | $275.42 | $501.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $52.48 / $107.15
| Professional | 26 | $28.18 | $52.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.19 / $457.09 / $933.25
| Professional | TC | $251.19 | $457.09 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $524.81 / $1,174.90
| Professional | | $302.00 | $524.81 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $56.23 / $120.23
| Professional | 26 | $32.36 | $56.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $269.15 / $467.74 / $1,047.13
| Professional | TC | $269.15 | $467.74 | $1,047.13 |