- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.37 / $146.06 / $182.56
| Facility | 26 | $60.37 | $146.06 | $182.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.85 / $210.85 / $1,512.03
| Professional | | $210.85 | $210.85 | $1,512.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $166.21 / $166.21 / $1,248.58
| Professional | TC | $166.21 | $166.21 | $1,248.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.59 / $235.45 / $1,140.45
| Professional | | $176.59 | $235.45 | $1,140.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $144.52 / $192.69 / $933.33
| Professional | TC | $144.52 | $192.69 | $933.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.54 / $313.69 / $458.53
| Professional | | $173.54 | $313.69 | $458.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $137.46 / $248.07 / $366.16
| Professional | TC | $137.46 | $248.07 | $366.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $101.86 / $198.60 / $198.60
| Facility | 26 | $101.86 | $198.60 | $198.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.02 / $226.76 / $1,396.18
| Professional | | $196.02 | $226.76 | $1,396.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $156.76 / $187.46 / $1,165.91
| Professional | TC | $156.76 | $187.46 | $1,165.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.02 / $226.76 / $506.88
| Professional | | $196.02 | $226.76 | $506.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $156.76 / $187.46 / $350.48
| Professional | TC | $156.76 | $187.46 | $350.48 |