- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $294.34 / $342.48 / $548.48
| Facility | 26 | $294.34 | $342.48 | $548.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.82 / $1,133.92 / $1,833.93
| Professional | | $1,012.82 | $1,133.92 | $1,833.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $272.25 / $340.44 / $781.42
| Professional | 26 | $272.25 | $340.44 | $781.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $728.19 / $815.25 / $1,292.44
| Professional | TC | $728.19 | $815.25 | $1,292.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.61 / $1,430.98 / $2,566.30
| Professional | | $1,000.61 | $1,430.98 | $2,566.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $287.55 / $399.52 / $632.18
| Professional | 26 | $287.55 | $399.52 | $632.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $685.42 / $1,008.84 / $1,496.61
| Professional | TC | $685.42 | $1,008.84 | $1,496.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $390.82 / $390.82 / $433.43
| Facility | 26 | $390.82 | $390.82 | $433.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.88 / $1,529.90 / $2,416.56
| Professional | | $1,141.88 | $1,529.90 | $2,416.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $328.26 / $458.18 / $695.36
| Professional | 26 | $328.26 | $458.18 | $695.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $828.05 / $1,080.01 / $1,723.21
| Professional | TC | $828.05 | $1,080.01 | $1,723.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.86 / $1,455.63 / $2,458.67
| Professional | | $1,091.86 | $1,455.63 | $2,458.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $308.17 / $435.55 / $687.98
| Professional | 26 | $308.17 | $435.55 | $687.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $764.86 / $1,024.60 / $1,769.83
| Professional | TC | $764.86 | $1,024.60 | $1,769.83 |