- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $45.71 / $120.23
| Facility | 26 | $30.20 | $45.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $741.31
| Professional | | $245.47 | $323.59 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $46.77 / $123.03
| Professional | 26 | $30.20 | $46.77 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.80 / $281.84 / $562.34
| Professional | TC | $213.80 | $281.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $776.25
| Professional | | $281.84 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $42.66 / $83.18
| Professional | 26 | $32.36 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $346.74 / $691.83
| Professional | TC | $257.04 | $346.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $47.86 / $147.91
| Facility | 26 | $8.51 | $47.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $478.63 / $891.25
| Professional | | $263.03 | $478.63 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $53.70 / $100.00
| Professional | 26 | $30.20 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $436.52 / $794.33
| Professional | TC | $239.88 | $436.52 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $741.31
| Professional | | $275.42 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $40.74 / $79.43
| Professional | 26 | $30.20 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.47 / $331.13 / $660.69
| Professional | TC | $245.47 | $331.13 | $660.69 |