- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.19 / $118.49 / $237.52
| Facility | 26 | $102.19 | $118.49 | $237.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.20 / $435.38 / $787.01
| Professional | | $381.20 | $435.38 | $787.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.71 / $104.43 / $231.29
| Professional | 26 | $90.71 | $104.43 | $231.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $285.00 / $323.22 / $515.44
| Professional | TC | $285.00 | $323.22 | $515.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.86 / $512.29 / $795.71
| Professional | | $390.86 | $512.29 | $795.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.79 / $121.53 / $203.94
| Professional | 26 | $97.79 | $121.53 | $203.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $291.89 / $400.68 / $595.41
| Professional | TC | $291.89 | $400.68 | $595.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $142.08 / $142.08 / $142.20
| Facility | 26 | $142.08 | $142.08 | $142.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.36 / $600.54 / $974.11
| Professional | | $435.36 | $600.54 | $974.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.75 / $143.25 / $237.27
| Professional | 26 | $109.75 | $143.25 | $237.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $325.62 / $460.11 / $732.79
| Professional | TC | $325.62 | $460.11 | $732.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.89 / $571.76 / $920.47
| Professional | | $417.89 | $571.76 | $920.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $101.72 / $135.54 / $217.78
| Professional | 26 | $101.72 | $135.54 | $217.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $312.98 / $434.39 / $691.45
| Professional | TC | $312.98 | $434.39 | $691.45 |