- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $100.00 / $169.82
| Facility | 26 | $33.88 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $251.19 / $467.74
| Professional | | $181.97 | $251.19 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $41.69 / $134.90
| Professional | 26 | $28.84 | $41.69 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $147.91 / $213.80 / $446.68
| Professional | TC | $147.91 | $213.80 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $194.98 / $616.60
| Professional | | $141.25 | $194.98 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $36.31 / $104.71
| Professional | 26 | $18.62 | $36.31 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.03 / $154.88 / $537.03
| Professional | TC | $123.03 | $154.88 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $52.48 / $120.23
| Facility | 26 | $10.00 | $52.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $234.42 / $549.54
| Professional | | $102.33 | $234.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $40.74 / $83.18
| Professional | 26 | $20.42 | $40.74 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.18 / $194.98 / $467.74
| Professional | TC | $83.18 | $194.98 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $630.96
| Professional | | $134.90 | $263.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $43.65 / $91.20
| Professional | 26 | $25.12 | $43.65 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $109.65 / $223.87 / $549.54
| Professional | TC | $109.65 | $223.87 | $549.54 |