- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $118.59 / $156.15 / $274.81
| Facility | 26 | $118.59 | $156.15 | $274.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.64 / $475.00 / $1,058.81
| Professional | | $350.64 | $475.00 | $1,058.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.00 / $154.00 / $382.50
| Professional | 26 | $110.00 | $154.00 | $382.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $238.22 / $335.00 / $532.14
| Professional | TC | $238.22 | $335.00 | $532.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.52 / $121.52 / $121.52
| Facility | 26 | $121.52 | $121.52 | $121.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.20 / $459.33 / $975.78
| Professional | | $339.20 | $459.33 | $975.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.75 / $145.33 / $259.91
| Professional | 26 | $107.75 | $145.33 | $259.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $226.20 / $315.74 / $834.27
| Professional | TC | $226.20 | $315.74 | $834.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $124.22 / $124.22 / $124.22
| Facility | 26 | $124.22 | $124.22 | $124.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.47 / $686.14 / $1,342.48
| Professional | | $328.47 | $686.14 | $1,342.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $101.26 / $159.85 / $270.00
| Professional | 26 | $101.26 | $159.85 | $270.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $221.22 / $471.60 / $1,120.83
| Professional | TC | $221.22 | $471.60 | $1,120.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.69 / $569.52 / $1,191.39
| Professional | | $333.69 | $569.52 | $1,191.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.36 / $136.97 / $239.20
| Professional | 26 | $104.36 | $136.97 | $239.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.57 / $384.36 / $905.58
| Professional | TC | $229.57 | $384.36 | $905.58 |