- 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
- $330.86 / $475.00 / $526.19
| Professional | | $330.86 | $475.00 | $526.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.27 / $140.00 / $179.07
| Professional | 26 | $109.27 | $140.00 | $179.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $221.58 / $335.00 / $347.13
| Professional | TC | $221.58 | $335.00 | $347.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.00 / $1,402.00 / $2,590.00
| Professional | | $853.00 | $1,402.00 | $2,590.00 |
- 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
- $576.00 / $947.00 / $1,750.00
| Professional | TC | $576.00 | $947.00 | $1,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.79 / $742.19 / $1,512.32
| Professional | | $494.79 | $742.19 | $1,512.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $128.74 / $194.61 / $408.57
| Professional | 26 | $128.74 | $194.61 | $408.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $340.91 / $565.00 / $1,199.09
| Professional | TC | $340.91 | $565.00 | $1,199.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.49 / $719.52 / $2,175.81
| Professional | | $578.49 | $719.52 | $2,175.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.80 / $205.98 / $383.91
| Professional | 26 | $100.80 | $205.98 | $383.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $396.49 / $508.28 / $1,810.60
| Professional | TC | $396.49 | $508.28 | $1,810.60 |