- 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
- $336.44 / $475.00 / $1,022.33
| Professional | | $336.44 | $475.00 | $1,022.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.31 / $152.13 / $370.46
| Professional | 26 | $109.31 | $152.13 | $370.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $227.54 / $335.00 / $480.00
| Professional | TC | $227.54 | $335.00 | $480.00 |
- 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
- $340.13 / $459.12 / $972.12
| Professional | | $340.13 | $459.12 | $972.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.75 / $145.33 / $259.02
| Professional | 26 | $107.75 | $145.33 | $259.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $227.14 / $316.70 / $836.01
| Professional | TC | $227.14 | $316.70 | $836.01 |
- 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
- $329.09 / $686.76 / $1,347.48
| Professional | | $329.09 | $686.76 | $1,347.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.44 / $157.99 / $268.48
| Professional | 26 | $100.44 | $157.99 | $268.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $221.50 / $484.88 / $1,120.83
| Professional | TC | $221.50 | $484.88 | $1,120.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.61 / $581.16 / $1,159.02
| Professional | | $327.61 | $581.16 | $1,159.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.68 / $135.08 / $237.32
| Professional | 26 | $103.68 | $135.08 | $237.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $225.21 / $390.30 / $892.05
| Professional | TC | $225.21 | $390.30 | $892.05 |