- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.54 / $85.54 / $87.11
| Facility | 26 | $85.54 | $85.54 | $87.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.58 / $338.06 / $495.62
| Professional | | $242.58 | $338.06 | $495.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.39 / $91.68 / $119.69
| Professional | 26 | $82.39 | $91.68 | $119.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $159.21 / $218.37 / $403.94
| Professional | TC | $159.21 | $218.37 | $403.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.00 / $1,414.00 / $1,414.00
| Professional | | $861.00 | $1,414.00 | $1,414.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $227.00 / $373.00 / $373.00
| Professional | 26 | $227.00 | $373.00 | $373.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $634.00 / $1,041.00 / $1,041.00
| Professional | TC | $634.00 | $1,041.00 | $1,041.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.49 / $583.47 / $987.53
| Professional | | $458.49 | $583.47 | $987.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.18 / $139.22 / $248.91
| Professional | 26 | $104.18 | $139.22 | $248.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $333.01 / $435.82 / $717.25
| Professional | TC | $333.01 | $435.82 | $717.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.79 / $649.62 / $1,520.19
| Professional | | $407.79 | $649.62 | $1,520.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.16 / $168.60 / $295.91
| Professional | 26 | $81.16 | $168.60 | $295.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $326.63 / $511.26 / $1,244.08
| Professional | TC | $326.63 | $511.26 | $1,244.08 |