- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.33 / $81.33 / $82.82
| Facility | 26 | $81.33 | $81.33 | $82.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.69 / $475.00 / $550.83
| Professional | | $347.69 | $475.00 | $550.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.20 / $139.66 / $140.00
| Professional | 26 | $85.20 | $139.66 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $262.49 / $335.00 / $411.16
| Professional | TC | $262.49 | $335.00 | $411.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.00 / $1,483.00 / $2,740.00
| Professional | | $903.00 | $1,483.00 | $2,740.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $216.00 / $355.00 / $656.00
| Professional | 26 | $216.00 | $355.00 | $656.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $687.00 / $1,128.00 / $2,084.00
| Professional | TC | $687.00 | $1,128.00 | $2,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.42 / $672.87 / $1,130.91
| Professional | | $498.42 | $672.87 | $1,130.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.06 / $131.90 / $234.95
| Professional | 26 | $98.06 | $131.90 | $234.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $405.52 / $552.19 / $873.43
| Professional | TC | $405.52 | $552.19 | $873.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.32 / $756.42 / $1,761.11
| Professional | | $471.32 | $756.42 | $1,761.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.25 / $159.72 / $277.20
| Professional | 26 | $76.25 | $159.72 | $277.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $395.07 / $543.36 / $1,483.91
| Professional | TC | $395.07 | $543.36 | $1,483.91 |