- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $162.18 / $446.68
| Facility | 26 | $104.71 | $162.18 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $977.24
| Professional | | $269.15 | $371.54 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $151.36 / $398.11
| Professional | 26 | $95.50 | $151.36 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $229.09 / $501.19
| Professional | TC | $162.18 | $229.09 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $1,047.13
| Professional | | $275.42 | $426.58 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $138.04 / $269.15
| Professional | 26 | $102.33 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $186.21 / $309.03 / $776.25
| Professional | TC | $186.21 | $309.03 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $147.91 / $354.81
| Facility | 26 | $27.54 | $147.91 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $645.65 / $1,258.93
| Professional | | $331.13 | $645.65 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $151.36 / $309.03
| Professional | 26 | $85.11 | $151.36 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $478.63 / $933.25
| Professional | TC | $239.88 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $977.24
| Professional | | $363.08 | $537.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $125.89 / $239.88
| Professional | 26 | $95.50 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $398.11 / $741.31
| Professional | TC | $263.03 | $398.11 | $741.31 |