- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.92 / $79.92 / $81.76
| Facility | 26 | $79.92 | $79.92 | $81.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.17 / $468.76 / $2,516.40
| Professional | | $427.17 | $468.76 | $2,516.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.45 / $222.00 / $1,086.80
| Professional | 26 | $79.45 | $222.00 | $1,086.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $347.25 / $385.75 / $2,107.21
| Professional | TC | $347.25 | $385.75 | $2,107.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.00 / $1,679.00 / $1,679.00
| Professional | | $936.00 | $1,679.00 | $1,679.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $169.00 / $304.00 / $304.00
| Professional | 26 | $169.00 | $304.00 | $304.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $767.00 / $1,375.00 / $1,375.00
| Professional | TC | $767.00 | $1,375.00 | $1,375.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.93 / $690.69 / $1,777.08
| Professional | | $664.93 | $690.69 | $1,777.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.19 / $128.35 / $297.04
| Professional | 26 | $105.19 | $128.35 | $297.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $559.73 / $561.33 / $1,480.04
| Professional | TC | $559.73 | $561.33 | $1,480.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.39 / $844.80 / $1,524.42
| Professional | | $569.39 | $844.80 | $1,524.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.37 / $141.60 / $255.51
| Professional | 26 | $92.37 | $141.60 | $255.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $477.02 / $703.20 / $1,268.91
| Professional | TC | $477.02 | $703.20 | $1,268.91 |