- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.00 / $111.15 / $173.01
| Facility | 26 | $85.00 | $111.15 | $173.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.81 / $475.00 / $692.52
| Professional | | $305.81 | $475.00 | $692.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.72 / $126.00 / $200.20
| Professional | 26 | $70.72 | $126.00 | $200.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $232.59 / $335.00 / $472.35
| Professional | TC | $232.59 | $335.00 | $472.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.23 / $77.23 / $77.23
| Facility | 26 | $77.23 | $77.23 | $77.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.14 / $415.22 / $824.64
| Professional | | $309.14 | $415.22 | $824.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.13 / $90.51 / $149.00
| Professional | 26 | $67.13 | $90.51 | $149.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $241.95 / $329.33 / $704.62
| Professional | TC | $241.95 | $329.33 | $704.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.09 / $79.09 / $79.09
| Facility | 26 | $79.09 | $79.09 | $79.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.97 / $578.23 / $965.77
| Professional | | $339.97 | $578.23 | $965.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.16 / $98.85 / $171.71
| Professional | 26 | $62.16 | $98.85 | $171.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $272.54 / $474.36 / $814.49
| Professional | TC | $272.54 | $474.36 | $814.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.27 / $501.90 / $921.55
| Professional | | $347.27 | $501.90 | $921.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.81 / $84.11 / $150.83
| Professional | 26 | $63.81 | $84.11 | $150.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $285.08 / $423.71 / $743.52
| Professional | TC | $285.08 | $423.71 | $743.52 |