- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $316.23 / $489.78
| Facility | 26 | $97.72 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $489.78
| Professional | | $151.36 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $107.15 / $457.09
| Professional | 26 | $77.62 | $107.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.61 / $97.72 / $186.21
| Professional | TC | $67.61 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $223.87 / $562.34
| Professional | | $109.65 | $223.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $117.49 / $302.00
| Professional | 26 | $51.29 | $117.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.23 / $79.43 / $269.15
| Professional | TC | $56.23 | $79.43 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $154.88 / $309.03
| Facility | 26 | $28.84 | $154.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $229.09 / $478.63
| Professional | | $112.20 | $229.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $123.03 / $263.03
| Professional | 26 | $58.88 | $123.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.98 / $97.72 / $234.42
| Professional | TC | $48.98 | $97.72 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $478.63
| Professional | | $134.90 | $223.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $125.89 / $269.15
| Professional | 26 | $72.44 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.88 / $100.00 / $223.87
| Professional | TC | $58.88 | $100.00 | $223.87 |