- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.65 / $106.89 / $509.57
| Facility | 26 | $93.65 | $106.89 | $509.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.50 / $968.07 / $1,303.18
| Professional | | $750.50 | $968.07 | $1,303.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $659.45 / $869.69 / $1,170.74
| Professional | TC | $659.45 | $869.69 | $1,170.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.63 / $970.08 / $1,815.14
| Professional | | $620.63 | $970.08 | $1,815.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $632.38 / $890.09 / $1,720.15
| Professional | TC | $632.38 | $890.09 | $1,720.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $155.29 / $155.29 / $155.29
| Facility | 26 | $155.29 | $155.29 | $155.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.54 / $1,087.20 / $2,074.98
| Professional | | $442.54 | $1,087.20 | $2,074.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $278.86 / $959.01 / $1,859.22
| Professional | TC | $278.86 | $959.01 | $1,859.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $227.00 / $478.18 / $478.18
| Facility | 26 | $227.00 | $478.18 | $478.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,422.07 / $6,422.07 / $7,978.20
| Professional | | $6,422.07 | $6,422.07 | $7,978.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5,800.59 / $5,800.59 / $7,141.13
| Professional | TC | $5,800.59 | $5,800.59 | $7,141.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.35 / $934.49 / $2,231.96
| Professional | | $351.35 | $934.49 | $2,231.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $510.28 / $813.25 / $1,941.05
| Professional | TC | $510.28 | $813.25 | $1,941.05 |