- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $112.20 / $295.12
| Facility | 26 | $79.43 | $112.20 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $363.08 / $1,047.13
| Professional | | $229.09 | $363.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $93.33 / $288.40
| Professional | 26 | $74.13 | $93.33 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $229.09 / $562.34
| Professional | TC | $162.18 | $229.09 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | 26 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $380.19 / $812.83
| Professional | | $257.04 | $380.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $109.65 / $204.17
| Professional | 26 | $81.28 | $109.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $275.42 / $645.65
| Professional | TC | $190.55 | $275.42 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $107.15 / $263.03
| Facility | 26 | $19.95 | $107.15 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $501.19 / $977.24
| Professional | | $251.19 | $501.19 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $112.20 / $229.09
| Professional | 26 | $66.07 | $112.20 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.83 / $380.19 / $776.25
| Professional | TC | $177.83 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $416.87 / $776.25
| Professional | | $257.04 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $93.33 / $177.83
| Professional | 26 | $70.79 | $93.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.83 / $302.00 / $630.96
| Professional | TC | $177.83 | $302.00 | $630.96 |