- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.45 / $83.45 / $101.65
| Facility | 26 | $81.45 | $83.45 | $101.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.58 / $475.00 / $674.01
| Professional | | $268.58 | $475.00 | $674.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.76 / $119.21 / $211.46
| Professional | 26 | $64.76 | $119.21 | $211.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $217.98 / $335.00 / $499.00
| Professional | TC | $217.98 | $335.00 | $499.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.67 / $409.83 / $978.89
| Professional | | $294.67 | $409.83 | $978.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.55 / $90.73 / $132.15
| Professional | 26 | $67.55 | $90.73 | $132.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $222.24 / $318.55 / $771.80
| Professional | TC | $222.24 | $318.55 | $771.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $129.03 / $129.03 / $129.03
| Facility | 26 | $129.03 | $129.03 | $129.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.12 / $517.13 / $913.88
| Professional | | $303.12 | $517.13 | $913.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.96 / $85.09 / $154.53
| Professional | 26 | $57.96 | $85.09 | $154.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $238.13 / $407.18 / $735.00
| Professional | TC | $238.13 | $407.18 | $735.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.33 / $572.33 / $614.61
| Professional | | $572.33 | $572.33 | $614.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.18 / $510.46 / $758.00
| Professional | | $402.18 | $510.46 | $758.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.45 / $103.37 / $237.64
| Professional | 26 | $81.45 | $103.37 | $237.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $320.74 / $407.09 / $758.00
| Professional | TC | $320.74 | $407.09 | $758.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.28 / $602.05 / $960.84
| Professional | | $374.28 | $602.05 | $960.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.95 / $113.64 / $173.73
| Professional | 26 | $57.95 | $113.64 | $173.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $289.08 / $462.53 / $756.07
| Professional | TC | $289.08 | $462.53 | $756.07 |