- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $219.42 / $219.42 / $224.47
| Facility | 26 | $219.42 | $219.42 | $224.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.72 / $481.44 / $2,406.51
| Professional | | $470.72 | $481.44 | $2,406.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $219.42 / $690.00 / $1,938.95
| Professional | 26 | $219.42 | $690.00 | $1,938.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.30 / $254.66 / $1,179.78
| Professional | TC | $251.30 | $254.66 | $1,179.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.00 / $1,772.00 / $1,772.00
| Professional | | $988.00 | $1,772.00 | $1,772.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $463.00 / $831.00 / $831.00
| Professional | 26 | $463.00 | $831.00 | $831.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $525.00 / $941.00 / $941.00
| Professional | TC | $525.00 | $941.00 | $941.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.51 / $723.60 / $1,739.41
| Professional | | $638.51 | $723.60 | $1,739.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $291.25 / $353.86 / $810.81
| Professional | 26 | $291.25 | $353.86 | $810.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $347.26 / $369.75 / $928.61
| Professional | TC | $347.26 | $369.75 | $928.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.01 / $961.22 / $1,809.50
| Professional | | $625.01 | $961.22 | $1,809.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $271.44 / $386.41 / $705.11
| Professional | 26 | $271.44 | $386.41 | $705.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $343.77 / $512.65 / $1,104.39
| Professional | TC | $343.77 | $512.65 | $1,104.39 |