- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $117.49 / $190.55
| Facility | 26 | $38.90 | $117.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $691.83
| Professional | | $302.00 | $371.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $40.74 / $95.50
| Professional | 26 | $30.90 | $40.74 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $331.13 / $602.56
| Professional | TC | $263.03 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $1,000.00
| Professional | | $218.78 | $354.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $36.31 / $104.71
| Professional | 26 | $20.89 | $36.31 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.98 / $309.03 / $891.25
| Professional | TC | $194.98 | $309.03 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $61.66 / $120.23
| Facility | 26 | $11.48 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $398.11 / $870.96
| Professional | | $190.55 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $45.71 / $93.33
| Professional | 26 | $22.91 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.82 / $346.74 / $776.25
| Professional | TC | $169.82 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $407.38 / $891.25
| Professional | | $245.47 | $407.38 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $48.98 / $102.33
| Professional | 26 | $27.54 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.80 / $363.08 / $794.33
| Professional | TC | $213.80 | $363.08 | $794.33 |