- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $186.34 / $224.71 / $376.96
| Facility | 26 | $186.34 | $224.71 | $376.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.81 / $591.38 / $754.19
| Professional | | $372.81 | $591.38 | $754.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $186.34 / $231.59 / $391.54
| Professional | 26 | $186.34 | $231.59 | $391.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $186.47 / $348.92 / $381.89
| Professional | TC | $186.47 | $348.92 | $381.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.58 / $337.58 / $337.58
| Professional | | $337.58 | $337.58 | $337.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $166.20 / $232.68 / $519.38
| Professional | 26 | $166.20 | $232.68 | $519.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.00 / $1,304.00 / $1,304.00
| Professional | | $1,304.00 | $1,304.00 | $1,304.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.81 / $796.43 / $1,202.89
| Professional | | $397.81 | $796.43 | $1,202.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $191.32 / $342.33 / $442.45
| Professional | 26 | $191.32 | $342.33 | $442.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $206.49 / $388.12 / $772.36
| Professional | TC | $206.49 | $388.12 | $772.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.43 / $543.33 / $1,505.68
| Professional | | $408.43 | $543.33 | $1,505.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $191.33 / $262.70 / $518.78
| Professional | 26 | $191.33 | $262.70 | $518.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $212.49 / $277.42 / $884.64
| Professional | TC | $212.49 | $277.42 | $884.64 |