- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $158.49 / $416.87
| Facility | 26 | $107.15 | $158.49 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $2,238.72
| Professional | | $346.74 | $537.03 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $177.83 / $478.63
| Professional | 26 | $97.72 | $177.83 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $346.74 / $912.01
| Professional | TC | $239.88 | $346.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Facility | 26 | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $549.54 / $1,479.11
| Professional | | $346.74 | $549.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $125.89 / $251.19
| Professional | 26 | $97.72 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $407.38 / $1,230.27
| Professional | TC | $257.04 | $407.38 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $134.90 / $331.13
| Facility | 26 | $25.70 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $660.69 / $1,412.54
| Professional | | $338.84 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $147.91 / $288.40
| Professional | 26 | $85.11 | $147.91 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $501.19 / $1,174.90
| Professional | TC | $239.88 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $1,202.26
| Professional | | $338.84 | $575.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $117.49 / $229.09
| Professional | 26 | $89.13 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $416.87 / $977.24
| Professional | TC | $239.88 | $416.87 | $977.24 |