- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.59 / $66.59 / $67.84
| Facility | 26 | $66.59 | $66.59 | $67.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.56 / $438.31 / $475.00
| Professional | | $276.56 | $438.31 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.56 / $115.62 / $140.00
| Professional | 26 | $70.56 | $115.62 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $205.98 / $322.69 / $335.00
| Professional | TC | $205.98 | $322.69 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.00 / $1,166.00 / $2,154.00
| Professional | | $710.00 | $1,166.00 | $2,154.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $178.00 / $292.00 / $539.00
| Professional | 26 | $178.00 | $292.00 | $539.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $532.00 / $874.00 / $1,615.00
| Professional | TC | $532.00 | $874.00 | $1,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.57 / $565.30 / $1,000.00
| Professional | | $390.57 | $565.30 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.64 / $121.92 / $263.83
| Professional | 26 | $80.64 | $121.92 | $263.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $310.99 / $419.30 / $796.72
| Professional | TC | $310.99 | $419.30 | $796.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.68 / $604.59 / $1,349.70
| Professional | | $384.68 | $604.59 | $1,349.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.38 / $133.10 / $227.37
| Professional | 26 | $62.38 | $133.10 | $227.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $322.30 / $458.32 / $1,123.08
| Professional | TC | $322.30 | $458.32 | $1,123.08 |