- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $89.13 / $234.42
| Facility | 26 | $63.10 | $89.13 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $302.00 / $1,122.02
| Professional | | $186.21 | $302.00 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $100.00 / $257.04
| Professional | 26 | $60.26 | $100.00 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $117.49 / $199.53 / $467.74
| Professional | TC | $117.49 | $199.53 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Facility | 26 | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $302.00 / $562.34
| Professional | | $186.21 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $87.10 / $158.49
| Professional | 26 | $64.57 | $87.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.82 / $213.80 / $416.87
| Professional | TC | $128.82 | $213.80 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $85.11 / $208.93
| Facility | 26 | $15.85 | $85.11 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $316.23 / $588.84
| Professional | | $173.78 | $316.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $89.13 / $181.97
| Professional | 26 | $52.48 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $117.49 / $223.87 / $416.87
| Professional | TC | $117.49 | $223.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $467.74
| Professional | | $173.78 | $263.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $74.13 / $141.25
| Professional | 26 | $56.23 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.82 / $181.97 / $338.84
| Professional | TC | $114.82 | $181.97 | $338.84 |