- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.47 / $104.47 / $106.41
| Facility | 26 | $104.47 | $104.47 | $106.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.83 / $475.00 / $527.72
| Professional | | $331.83 | $475.00 | $527.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.73 / $140.00 / $260.75
| Professional | 26 | $95.73 | $140.00 | $260.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $222.56 / $335.00 / $348.65
| Professional | TC | $222.56 | $335.00 | $348.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.00 / $1,405.00 / $2,595.00
| Professional | | $855.00 | $1,405.00 | $2,595.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $277.00 / $455.00 / $840.00
| Professional | 26 | $277.00 | $455.00 | $840.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $578.00 / $950.00 / $1,755.00
| Professional | TC | $578.00 | $950.00 | $1,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.98 / $743.98 / $1,545.32
| Professional | | $495.98 | $743.98 | $1,545.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $139.94 / $211.61 / $408.57
| Professional | 26 | $139.94 | $211.61 | $408.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $343.23 / $565.00 / $1,206.43
| Professional | TC | $343.23 | $565.00 | $1,206.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.60 / $720.91 / $2,209.91
| Professional | | $579.60 | $720.91 | $2,209.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.45 / $205.99 / $397.10
| Professional | 26 | $109.45 | $205.99 | $397.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $397.60 / $509.44 / $1,812.81
| Professional | TC | $397.60 | $509.44 | $1,812.81 |