- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.56 / $91.46 / $146.28
| Facility | 26 | $73.56 | $91.46 | $146.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.70 / $307.08 / $361.25
| Professional | | $294.70 | $307.08 | $361.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.15 / $61.31 / $76.12
| Professional | 26 | $57.15 | $61.31 | $76.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.03 / $243.88 / $285.12
| Professional | TC | $233.03 | $243.88 | $285.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.00 / $613.00 / $613.00
| Professional | | $613.00 | $613.00 | $613.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.11 / $479.00 / $603.79
| Professional | | $290.11 | $479.00 | $603.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.11 / $94.16 / $117.13
| Professional | 26 | $58.11 | $94.16 | $117.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $232.00 / $376.11 / $486.67
| Professional | TC | $232.00 | $376.11 | $486.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.49 / $151.49 / $151.49
| Facility | 26 | $151.49 | $151.49 | $151.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.54 / $452.82 / $2,079.76
| Professional | | $347.54 | $452.82 | $2,079.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.56 / $95.11 / $405.29
| Professional | 26 | $68.56 | $95.11 | $405.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $278.97 / $361.23 / $1,674.47
| Professional | TC | $278.97 | $361.23 | $1,674.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.16 / $404.58 / $649.04
| Professional | | $330.16 | $404.58 | $649.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.84 / $91.59 / $139.97
| Professional | 26 | $67.84 | $91.59 | $139.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $265.02 / $311.57 / $517.77
| Professional | TC | $265.02 | $311.57 | $517.77 |