- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.43 / $176.50 / $198.76
| Facility | 26 | $108.43 | $176.50 | $198.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.00 / $481.42 / $841.25
| Professional | | $475.00 | $481.42 | $841.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $111.15 / $138.60 / $210.05
| Professional | 26 | $111.15 | $138.60 | $210.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $335.00 / $363.10 / $631.20
| Professional | TC | $335.00 | $363.10 | $631.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.44 / $600.44 / $600.44
| Professional | | $600.44 | $600.44 | $600.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.54 / $550.49 / $827.00
| Professional | | $283.54 | $550.49 | $827.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.67 / $119.69 / $159.65
| Professional | 26 | $71.67 | $119.69 | $159.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $235.14 / $431.41 / $714.07
| Professional | TC | $235.14 | $431.41 | $714.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $618.08 / $789.92 / $789.92
| Facility | 26 | $618.08 | $789.92 | $789.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.56 / $601.66 / $3,014.38
| Professional | | $402.56 | $601.66 | $3,014.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.80 / $109.75 / $597.70
| Professional | 26 | $81.80 | $109.75 | $597.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $308.30 / $476.85 / $2,544.17
| Professional | TC | $308.30 | $476.85 | $2,544.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.17 / $550.10 / $736.74
| Professional | | $380.17 | $550.10 | $736.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.80 / $100.05 / $154.62
| Professional | 26 | $81.80 | $100.05 | $154.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $300.98 / $457.91 / $569.10
| Professional | TC | $300.98 | $457.91 | $569.10 |