- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.26 / $107.12 / $186.46
| Facility | 26 | $83.26 | $107.12 | $186.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.27 / $385.88 / $673.37
| Professional | | $249.27 | $385.88 | $673.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.08 / $88.86 / $245.12
| Professional | 26 | $74.08 | $88.86 | $245.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $168.49 / $295.64 / $480.94
| Professional | TC | $168.49 | $295.64 | $480.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.92 / $92.92 / $92.92
| Facility | 26 | $92.92 | $92.92 | $92.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.83 / $372.80 / $770.93
| Professional | | $273.83 | $372.80 | $770.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.31 / $111.16 / $182.76
| Professional | 26 | $81.31 | $111.16 | $182.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.00 / $265.81 / $594.46
| Professional | TC | $190.00 | $265.81 | $594.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.56 / $94.56 / $94.56
| Facility | 26 | $94.56 | $94.56 | $94.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.48 / $521.28 / $920.63
| Professional | | $277.48 | $521.28 | $920.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.79 / $117.51 / $198.51
| Professional | 26 | $73.79 | $117.51 | $198.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.09 / $392.22 / $709.66
| Professional | TC | $194.09 | $392.22 | $709.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.83 / $451.49 / $771.27
| Professional | | $262.83 | $451.49 | $771.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.08 / $98.48 / $179.00
| Professional | 26 | $76.08 | $98.48 | $179.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $187.29 / $322.11 / $630.24
| Professional | TC | $187.29 | $322.11 | $630.24 |