- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $117.14 / $117.14 / $119.32
| Facility | 26 | $117.14 | $117.14 | $119.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.90 / $475.00 / $607.29
| Professional | | $381.90 | $475.00 | $607.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $122.94 / $140.00 / $253.40
| Professional | 26 | $122.94 | $140.00 | $253.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $258.95 / $335.00 / $405.68
| Professional | TC | $258.95 | $335.00 | $405.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.00 / $1,596.00 / $2,950.00
| Professional | | $972.00 | $1,596.00 | $2,950.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $310.00 / $509.00 / $941.00
| Professional | 26 | $310.00 | $509.00 | $941.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $662.00 / $1,087.00 / $2,009.00
| Professional | TC | $662.00 | $1,087.00 | $2,009.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.09 / $777.86 / $1,400.00
| Professional | | $541.09 | $777.86 | $1,400.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $144.60 / $218.53 / $420.00
| Professional | 26 | $144.60 | $218.53 | $420.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $383.11 / $531.75 / $984.62
| Professional | TC | $383.11 | $531.75 | $984.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.35 / $823.30 / $1,969.01
| Professional | | $475.35 | $823.30 | $1,969.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.06 / $251.44 / $426.81
| Professional | 26 | $112.06 | $251.44 | $426.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $366.86 / $571.86 / $1,422.28
| Professional | TC | $366.86 | $571.86 | $1,422.28 |