- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $538.14 / $538.14 / $538.14
| Facility | 26 | $538.14 | $538.14 | $538.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.87 / $571.12 / $600.00
| Professional | | $372.87 | $571.12 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.19 / $140.00 / $180.00
| Professional | 26 | $90.19 | $140.00 | $180.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $282.68 / $420.00 / $452.76
| Professional | TC | $282.68 | $420.00 | $452.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.58 / $499.51 / $939.79
| Professional | | $424.58 | $499.51 | $939.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.85 / $121.22 / $167.84
| Professional | 26 | $84.85 | $121.22 | $167.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $264.80 / $378.29 / $397.78
| Professional | TC | $264.80 | $378.29 | $397.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.40 / $718.14 / $837.79
| Professional | | $344.40 | $718.14 | $837.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.09 / $170.11 / $180.06
| Professional | 26 | $78.09 | $170.11 | $180.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $262.67 / $548.02 / $652.79
| Professional | TC | $262.67 | $548.02 | $652.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.93 / $498.18 / $706.05
| Professional | | $391.93 | $498.18 | $706.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.69 / $112.31 / $178.84
| Professional | 26 | $80.69 | $112.31 | $178.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $255.83 / $384.26 / $601.33
| Professional | TC | $255.83 | $384.26 | $601.33 |