- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $109.73 / $157.91 / $199.60
| Facility | 26 | $109.73 | $157.91 | $199.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.00 / $477.85 / $835.12
| Professional | | $475.00 | $477.85 | $835.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $118.81 / $139.18 / $211.00
| Professional | 26 | $118.81 | $139.18 | $211.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $335.00 / $359.04 / $624.12
| Professional | TC | $335.00 | $359.04 | $624.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.05 / $597.05 / $597.05
| Professional | | $597.05 | $597.05 | $597.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.70 / $559.01 / $829.00
| Professional | | $281.70 | $559.01 | $829.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.50 / $124.28 / $160.91
| Professional | 26 | $72.50 | $124.28 | $160.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.69 / $428.89 / $708.67
| Professional | TC | $233.69 | $428.89 | $708.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $620.48 / $795.52 / $795.52
| Facility | 26 | $620.48 | $795.52 | $795.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.66 / $603.15 / $3,018.44
| Professional | | $403.66 | $603.15 | $3,018.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.50 / $112.70 / $850.86
| Professional | 26 | $82.50 | $112.70 | $850.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $307.94 / $480.99 / $2,546.60
| Professional | TC | $307.94 | $480.99 | $2,546.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.87 / $551.49 / $737.47
| Professional | | $380.87 | $551.49 | $737.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.50 / $101.24 / $156.46
| Professional | 26 | $82.50 | $101.24 | $156.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.33 / $398.63 / $568.41
| Professional | TC | $288.33 | $398.63 | $568.41 |