- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.95 / $105.43 / $136.38
| Facility | 26 | $85.95 | $105.43 | $136.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $348.06 / $498.59
| Professional | | $295.12 | $348.06 | $498.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.01 / $91.48 / $147.59
| Professional | 26 | $84.01 | $91.48 | $147.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.76 / $256.00 / $364.72
| Professional | TC | $208.76 | $256.00 | $364.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.98 / $366.88 / $635.09
| Professional | | $272.98 | $366.88 | $635.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.84 / $112.00 / $171.51
| Professional | 26 | $82.84 | $112.00 | $171.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $182.70 / $272.52 / $461.35
| Professional | TC | $182.70 | $272.52 | $461.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.95 / $112.95 / $112.95
| Facility | 26 | $112.95 | $112.95 | $112.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.01 / $451.27 / $723.34
| Professional | | $296.01 | $451.27 | $723.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.35 / $129.22 / $207.61
| Professional | 26 | $88.35 | $129.22 | $207.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $211.77 / $311.95 / $469.62
| Professional | TC | $211.77 | $311.95 | $469.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.05 / $413.04 / $711.49
| Professional | | $288.05 | $413.04 | $711.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.68 / $120.79 / $202.04
| Professional | 26 | $86.68 | $120.79 | $202.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $202.63 / $284.99 / $489.52
| Professional | TC | $202.63 | $284.99 | $489.52 |