- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.20 / $78.20 / $79.66
| Facility | 26 | $78.20 | $78.20 | $79.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.44 / $475.00 / $498.53
| Professional | | $314.44 | $475.00 | $498.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.78 / $135.62 / $140.00
| Professional | 26 | $82.78 | $135.62 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $231.66 / $335.00 / $362.91
| Professional | TC | $231.66 | $335.00 | $362.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.00 / $1,333.00 / $2,463.00
| Professional | | $811.00 | $1,333.00 | $2,463.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $209.00 / $344.00 / $635.00
| Professional | 26 | $209.00 | $344.00 | $635.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $602.00 / $989.00 / $1,828.00
| Professional | TC | $602.00 | $989.00 | $1,828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.25 / $698.16 / $1,279.07
| Professional | | $495.25 | $698.16 | $1,279.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $94.20 / $142.44 / $309.14
| Professional | 26 | $94.20 | $142.44 | $309.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $367.61 / $533.19 / $1,029.59
| Professional | TC | $367.61 | $533.19 | $1,029.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.39 / $689.57 / $2,024.01
| Professional | | $531.39 | $689.57 | $2,024.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.36 / $152.52 / $279.39
| Professional | 26 | $73.36 | $152.52 | $279.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $416.64 / $518.22 / $1,565.30
| Professional | TC | $416.64 | $518.22 | $1,565.30 |