- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $106.74 / $136.05 / $192.60
| Facility | 26 | $106.74 | $136.05 | $192.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.05 / $475.00 / $885.38
| Professional | | $318.05 | $475.00 | $885.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.96 / $140.00 / $311.07
| Professional | 26 | $97.96 | $140.00 | $311.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $220.06 / $312.27 / $433.05
| Professional | TC | $220.06 | $312.27 | $433.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.58 / $121.58 / $121.58
| Facility | 26 | $121.58 | $121.58 | $121.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.02 / $441.72 / $760.61
| Professional | | $339.02 | $441.72 | $760.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.06 / $130.22 / $233.90
| Professional | 26 | $104.06 | $130.22 | $233.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $237.87 / $312.98 / $586.49
| Professional | TC | $237.87 | $312.98 | $586.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $124.62 / $124.62 / $124.62
| Facility | 26 | $124.62 | $124.62 | $124.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.73 / $530.95 / $900.27
| Professional | | $332.73 | $530.95 | $900.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.58 / $152.85 / $257.35
| Professional | 26 | $97.58 | $152.85 | $257.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.54 / $364.65 / $634.32
| Professional | TC | $229.54 | $364.65 | $634.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.34 / $630.19 / $1,236.43
| Professional | | $351.34 | $630.19 | $1,236.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.16 / $124.23 / $231.24
| Professional | 26 | $77.16 | $124.23 | $231.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $260.08 / $478.63 / $961.58
| Professional | TC | $260.08 | $478.63 | $961.58 |