- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.72 / $122.27 / $207.17
| Facility | 26 | $87.72 | $122.27 | $207.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.20 / $475.00 / $914.06
| Professional | | $327.20 | $475.00 | $914.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.16 / $140.00 / $246.35
| Professional | 26 | $79.16 | $140.00 | $246.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $252.76 / $335.00 / $487.65
| Professional | TC | $252.76 | $335.00 | $487.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.16 / $86.16 / $86.16
| Facility | 26 | $86.16 | $86.16 | $86.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.36 / $425.10 / $923.59
| Professional | | $317.36 | $425.10 | $923.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.48 / $94.70 / $165.49
| Professional | 26 | $71.48 | $94.70 | $165.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $253.57 / $344.02 / $756.70
| Professional | TC | $253.57 | $344.02 | $756.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.30 / $88.30 / $88.30
| Facility | 26 | $88.30 | $88.30 | $88.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.32 / $584.75 / $958.44
| Professional | | $321.32 | $584.75 | $958.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.67 / $109.84 / $185.14
| Professional | 26 | $68.67 | $109.84 | $185.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.51 / $473.13 / $772.47
| Professional | TC | $245.51 | $473.13 | $772.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.73 / $511.94 / $854.19
| Professional | | $331.73 | $511.94 | $854.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.86 / $93.52 / $169.43
| Professional | 26 | $70.86 | $93.52 | $169.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $250.23 / $390.81 / $726.78
| Professional | TC | $250.23 | $390.81 | $726.78 |