- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $144.28 / $183.03 / $214.36
| Facility | 26 | $144.28 | $183.03 | $214.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.00 / $556.90 / $827.40
| Professional | | $475.00 | $556.90 | $827.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $134.34 / $144.28 / $214.36
| Professional | 26 | $134.34 | $144.28 | $214.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $335.00 / $412.62 / $613.04
| Professional | TC | $335.00 | $412.62 | $613.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.02 / $77.79 / $152.00
| Professional | 26 | $47.02 | $77.79 | $152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.50 / $590.50 / $590.50
| Professional | | $590.50 | $590.50 | $590.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.14 / $628.45 / $946.96
| Professional | | $283.14 | $628.45 | $946.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.77 / $140.34 / $175.66
| Professional | 26 | $71.77 | $140.34 | $175.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $211.37 / $484.15 / $774.75
| Professional | TC | $211.37 | $484.15 | $774.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $261.64
| Professional | | $32.34 | $32.34 | $261.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.80 / $422.21 / $948.59
| Professional | | $326.80 | $422.21 | $948.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.06 / $100.44 / $206.38
| Professional | 26 | $71.06 | $100.44 | $206.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $258.52 / $323.60 / $780.84
| Professional | TC | $258.52 | $323.60 | $780.84 |