- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.00 / $119.40 / $178.75
| Facility | 26 | $83.00 | $119.40 | $178.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.67 / $475.00 / $817.34
| Professional | | $338.67 | $475.00 | $817.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.42 / $127.58 / $231.92
| Professional | 26 | $71.42 | $127.58 | $231.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $267.69 / $335.00 / $565.00
| Professional | TC | $267.69 | $335.00 | $565.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.45 / $95.45 / $95.45
| Facility | 26 | $95.45 | $95.45 | $95.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.87 / $561.17 / $1,006.09
| Professional | | $361.87 | $561.17 | $1,006.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.13 / $99.08 / $178.83
| Professional | 26 | $72.13 | $99.08 | $178.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $286.49 / $446.68 / $946.68
| Professional | TC | $286.49 | $446.68 | $946.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.26 / $80.26 / $80.26
| Facility | 26 | $80.26 | $80.26 | $80.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.68 / $786.64 / $1,370.07
| Professional | | $367.68 | $786.64 | $1,370.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.40 / $109.03 / $185.63
| Professional | 26 | $65.40 | $109.03 | $185.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $296.85 / $630.64 / $1,191.52
| Professional | TC | $296.85 | $630.64 | $1,191.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.58 / $641.75 / $1,148.01
| Professional | | $342.58 | $641.75 | $1,148.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.78 / $90.83 / $162.55
| Professional | 26 | $69.78 | $90.83 | $162.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $271.20 / $501.00 / $1,007.09
| Professional | TC | $271.20 | $501.00 | $1,007.09 |