- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $540.39 / $540.39 / $540.39
| Facility | 26 | $540.39 | $540.39 | $540.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.41 / $475.00 / $600.00
| Professional | | $298.41 | $475.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.21 / $140.00 / $470.00
| Professional | 26 | $90.21 | $140.00 | $470.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.20 / $335.00 / $420.00
| Professional | TC | $208.20 | $335.00 | $420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.93 / $398.74 / $951.99
| Professional | | $338.93 | $398.74 | $951.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.86 / $121.23 / $167.97
| Professional | 26 | $84.86 | $121.23 | $167.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.25 / $277.50 / $315.98
| Professional | TC | $194.25 | $277.50 | $315.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.07 / $574.28 / $807.31
| Professional | | $276.07 | $574.28 | $807.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.15 / $165.00 / $180.82
| Professional | 26 | $78.15 | $165.00 | $180.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.76 / $403.58 / $575.87
| Professional | TC | $190.76 | $403.58 | $575.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.42 / $490.79 / $715.50
| Professional | | $315.42 | $490.79 | $715.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.73 / $112.78 / $179.64
| Professional | 26 | $79.73 | $112.78 | $179.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.31 / $319.68 / $596.71
| Professional | TC | $223.31 | $319.68 | $596.71 |