- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $85.11 / $194.98
| Facility | 26 | $56.23 | $85.11 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $912.01
| Professional | | $371.54 | $457.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $70.79 / $218.78
| Professional | 26 | $52.48 | $70.79 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $323.59 / $380.19 / $741.31
| Professional | TC | $323.59 | $380.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $933.25
| Professional | | $346.74 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $70.79 / $138.04
| Professional | 26 | $50.12 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $295.12 / $416.87 / $794.33
| Professional | TC | $295.12 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $74.13 / $199.53
| Facility | 26 | $13.80 | $74.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $660.69 / $1,174.90
| Professional | | $407.38 | $660.69 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $97.72 / $158.49
| Professional | 26 | $58.88 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $346.74 / $575.44 / $1,023.29
| Professional | TC | $346.74 | $575.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $1,000.00
| Professional | | $354.81 | $537.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $81.28 / $144.54
| Professional | 26 | $51.29 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $302.00 / $457.09 / $851.14
| Professional | TC | $302.00 | $457.09 | $851.14 |