- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.28 / $66.28 / $67.53
| Facility | 26 | $66.28 | $66.28 | $67.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.47 / $460.01 / $475.00
| Professional | | $290.47 | $460.01 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.88 / $114.47 / $140.00
| Professional | 26 | $69.88 | $114.47 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $220.59 / $335.00 / $345.54
| Professional | TC | $220.59 | $335.00 | $345.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.00 / $1,491.00 / $2,756.00
| Professional | | $908.00 | $1,491.00 | $2,756.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $177.00 / $290.00 / $537.00
| Professional | 26 | $177.00 | $290.00 | $537.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $731.00 / $1,201.00 / $2,219.00
| Professional | TC | $731.00 | $1,201.00 | $2,219.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.81 / $667.86 / $1,200.00
| Professional | | $497.81 | $667.86 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.48 / $120.18 / $261.32
| Professional | 26 | $79.48 | $120.18 | $261.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $398.14 / $498.86 / $955.52
| Professional | TC | $398.14 | $498.86 | $955.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.01 / $719.95 / $1,662.10
| Professional | | $482.01 | $719.95 | $1,662.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.51 / $144.88 / $225.21
| Professional | 26 | $61.51 | $144.88 | $225.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $420.50 / $632.44 / $1,437.70
| Professional | TC | $420.50 | $632.44 | $1,437.70 |