- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $331.13 / $912.01
| Facility | 26 | $204.17 | $331.13 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $2,290.87
| Professional | | $389.05 | $588.84 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $338.84 / $831.76
| Professional | 26 | $199.53 | $338.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.17 / $323.59 / $851.14
| Professional | TC | $204.17 | $323.59 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $741.31 / $1,862.09
| Professional | | $457.09 | $741.31 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $218.78 / $295.12 / $537.03
| Professional | 26 | $218.78 | $295.12 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $446.68 / $1,348.96
| Professional | TC | $234.42 | $446.68 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $316.23 / $912.01
| Facility | 26 | $54.95 | $316.23 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $870.96 / $1,862.09
| Professional | | $457.09 | $870.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $208.93 / $338.84 / $660.69
| Professional | 26 | $208.93 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.47 / $457.09 / $1,174.90
| Professional | TC | $245.47 | $457.09 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $1,348.96
| Professional | | $436.52 | $676.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $186.21 / $269.15 / $489.78
| Professional | 26 | $186.21 | $269.15 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $363.08 / $912.01
| Professional | TC | $234.42 | $363.08 | $912.01 |