- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $237.05 / $398.71 / $452.92
| Facility | 26 | $237.05 | $398.71 | $452.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.74 / $838.74 / $1,440.39
| Professional | | $838.74 | $838.74 | $1,440.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $237.05 / $237.05 / $452.92
| Professional | 26 | $237.05 | $237.05 | $452.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $601.69 / $601.69 / $987.47
| Professional | TC | $601.69 | $601.69 | $987.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $264.39 / $264.39 / $264.39
| Professional | 26 | $264.39 | $264.39 | $264.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.41 / $1,023.75 / $1,405.76
| Professional | | $355.41 | $1,023.75 | $1,405.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.80 / $1,342.86 / $1,608.35
| Professional | | $995.80 | $1,342.86 | $1,608.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $295.68 / $399.71 / $510.05
| Professional | 26 | $295.68 | $399.71 | $510.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $700.12 / $943.15 / $1,117.86
| Professional | TC | $700.12 | $943.15 | $1,117.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,118.00 / $2,654.96 / $2,654.96
| Facility | 26 | $2,118.00 | $2,654.96 | $2,654.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.86 / $1,262.09 / $6,888.39
| Professional | | $932.86 | $1,262.09 | $6,888.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $256.41 / $386.16 / $1,791.90
| Professional | 26 | $256.41 | $386.16 | $1,791.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $654.50 / $906.83 / $5,096.49
| Professional | TC | $654.50 | $906.83 | $5,096.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.98 / $1,207.23 / $1,876.69
| Professional | | $877.98 | $1,207.23 | $1,876.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $247.14 / $357.82 / $528.27
| Professional | 26 | $247.14 | $357.82 | $528.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $630.84 / $860.66 / $1,248.27
| Professional | TC | $630.84 | $860.66 | $1,248.27 |