- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $93.33 / $239.88
| Facility | 26 | $64.57 | $93.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $1,202.26
| Professional | | $223.87 | $354.81 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $91.20 / $213.80
| Professional | 26 | $60.26 | $91.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $239.88 / $575.44
| Professional | TC | $162.18 | $239.88 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Facility | 26 | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $741.31
| Professional | | $245.47 | $354.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $89.13 / $162.18
| Professional | 26 | $64.57 | $89.13 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $263.03 / $588.84
| Professional | TC | $190.55 | $263.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $85.11 / $208.93
| Facility | 26 | $16.22 | $85.11 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $426.58 / $812.83
| Professional | | $229.09 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $91.20 / $186.21
| Professional | 26 | $53.70 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.82 / $331.13 / $645.65
| Professional | TC | $169.82 | $331.13 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $645.65
| Professional | | $234.42 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $75.86 / $144.54
| Professional | 26 | $56.23 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.78 / $275.42 / $512.86
| Professional | TC | $173.78 | $275.42 | $512.86 |