- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.09 / $137.44 / $187.29
| Facility | 26 | $104.09 | $137.44 | $187.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.38 / $475.00 / $756.49
| Professional | | $426.38 | $475.00 | $756.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $111.15 / $134.18 / $203.19
| Professional | 26 | $111.15 | $134.18 | $203.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $312.27 / $335.00 / $553.29
| Professional | TC | $312.27 | $335.00 | $553.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.00 / $576.00 / $576.00
| Professional | | $576.00 | $576.00 | $576.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.81 / $509.39 / $907.00
| Professional | | $253.81 | $509.39 | $907.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.19 / $108.58 / $155.22
| Professional | 26 | $69.19 | $108.58 | $155.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $207.54 / $404.57 / $764.00
| Professional | TC | $207.54 | $404.57 | $764.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $593.12 / $764.32 / $764.32
| Facility | 26 | $593.12 | $764.32 | $764.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.77 / $662.96 / $3,392.38
| Professional | | $368.77 | $662.96 | $3,392.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.56 / $116.91 / $667.05
| Professional | 26 | $78.56 | $116.91 | $667.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $275.02 / $546.20 / $2,981.99
| Professional | TC | $275.02 | $546.20 | $2,981.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.29 / $624.77 / $962.85
| Professional | | $357.29 | $624.77 | $962.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.56 / $97.66 / $168.52
| Professional | 26 | $78.56 | $97.66 | $168.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $268.51 / $494.44 / $671.75
| Professional | TC | $268.51 | $494.44 | $671.75 |