- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $109.65 / $295.12
| Facility | 26 | $67.61 | $109.65 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $467.74 / $1,698.24
| Professional | | $147.91 | $467.74 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $131.83 / $323.59
| Professional | 26 | $64.57 | $131.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $338.84 / $691.83
| Professional | TC | $218.78 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $891.25
| Professional | | $269.15 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $75.86 / $151.36
| Professional | 26 | $57.54 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.80 / $354.81 / $741.31
| Professional | TC | $213.80 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.49 / $83.18 / $204.17
| Facility | 26 | $15.49 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $524.81 / $977.24
| Professional | | $295.12 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $91.20 / $181.97
| Professional | 26 | $51.29 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $426.58 / $812.83
| Professional | TC | $234.42 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $812.83
| Professional | | $302.00 | $436.52 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $72.44 / $141.25
| Professional | 26 | $54.95 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $363.08 / $676.08
| Professional | TC | $239.88 | $363.08 | $676.08 |