- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.06 / $120.91 / $162.97
| Facility | 26 | $114.06 | $120.91 | $162.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.35 / $1,047.59 / $1,371.59
| Professional | | $944.35 | $1,047.59 | $1,371.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $94.96 / $126.04 / $148.09
| Professional | 26 | $94.96 | $126.04 | $148.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $849.37 / $921.56 / $1,223.50
| Professional | TC | $849.37 | $921.56 | $1,223.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.89 / $1,008.78 / $1,678.03
| Professional | | $948.89 | $1,008.78 | $1,678.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $122.32 / $144.41 / $186.99
| Professional | 26 | $122.32 | $144.41 | $186.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $815.92 / $933.51 / $1,491.03
| Professional | TC | $815.92 | $933.51 | $1,491.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.59 / $87.59 / $87.59
| Professional | 26 | $87.59 | $87.59 | $87.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.52 / $873.88 / $1,726.45
| Professional | | $485.52 | $873.88 | $1,726.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.95 / $98.46 / $205.47
| Professional | 26 | $62.95 | $98.46 | $205.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $422.58 / $741.19 / $1,520.97
| Professional | TC | $422.58 | $741.19 | $1,520.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.71 / $955.65 / $1,505.04
| Professional | | $748.71 | $955.65 | $1,505.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.74 / $107.93 / $168.52
| Professional | 26 | $83.74 | $107.93 | $168.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $599.91 / $807.70 / $1,443.29
| Professional | TC | $599.91 | $807.70 | $1,443.29 |