- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $141.25 / $407.38
| Facility | 26 | $91.20 | $141.25 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,949.84
| Professional | | $354.81 | $512.86 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $144.54 / $331.13
| Professional | 26 | $85.11 | $144.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $363.08 / $870.96
| Professional | TC | $257.04 | $363.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Facility | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,412.54
| Professional | | $354.81 | $575.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $112.20 / $208.93
| Professional | 26 | $83.18 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $281.84 / $467.74 / $1,230.27
| Professional | TC | $281.84 | $467.74 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $109.65 / $269.15
| Facility | 26 | $20.89 | $109.65 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $758.58 / $1,445.44
| Professional | | $354.81 | $758.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $123.03 / $245.47
| Professional | 26 | $69.18 | $123.03 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $588.84 / $1,258.93
| Professional | TC | $263.03 | $588.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,202.26
| Professional | | $338.84 | $602.56 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $95.50 / $186.21
| Professional | 26 | $70.79 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $478.63 / $1,047.13
| Professional | TC | $257.04 | $478.63 | $1,047.13 |