- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.17 / $79.17 / $80.66
| Facility | 26 | $79.17 | $79.17 | $80.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.84 / $329.76 / $488.49
| Professional | | $236.84 | $329.76 | $488.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.65 / $84.14 / $154.81
| Professional | 26 | $75.65 | $84.14 | $154.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $159.21 / $218.37 / $404.35
| Professional | TC | $159.21 | $218.37 | $404.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.00 / $1,205.00 / $1,205.00
| Professional | | $734.00 | $1,205.00 | $1,205.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $212.00 / $348.00 / $348.00
| Professional | 26 | $212.00 | $348.00 | $348.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $522.00 / $857.00 / $857.00
| Professional | TC | $522.00 | $857.00 | $857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.09 / $635.52 / $1,052.77
| Professional | | $386.09 | $635.52 | $1,052.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.71 / $144.69 / $252.48
| Professional | 26 | $95.71 | $144.69 | $252.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $268.86 / $436.62 / $774.41
| Professional | TC | $268.86 | $436.62 | $774.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.60 / $581.61 / $1,915.11
| Professional | | $467.60 | $581.61 | $1,915.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.51 / $157.18 / $270.61
| Professional | 26 | $74.51 | $157.18 | $270.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $328.72 / $408.87 / $1,644.50
| Professional | TC | $328.72 | $408.87 | $1,644.50 |