- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $125.89 / $338.84
| Facility | 26 | $85.11 | $125.89 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $446.68 / $1,698.24
| Professional | | $302.00 | $446.68 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $123.03 / $338.84
| Professional | 26 | $85.11 | $123.03 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $323.59 / $645.65
| Professional | TC | $218.78 | $323.59 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $912.01
| Professional | | $302.00 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $123.03 / $234.42
| Professional | 26 | $91.20 | $123.03 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $316.23 / $707.95
| Professional | TC | $223.87 | $316.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $123.03 / $302.00
| Facility | 26 | $23.44 | $123.03 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $524.81 / $1,023.29
| Professional | | $288.40 | $524.81 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $131.83 / $263.03
| Professional | 26 | $74.13 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.80 / $389.05 / $758.58
| Professional | TC | $213.80 | $389.05 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $794.33
| Professional | | $309.03 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $109.65 / $204.17
| Professional | 26 | $81.28 | $109.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $316.23 / $588.84
| Professional | TC | $223.87 | $316.23 | $588.84 |