- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.32 / $78.56 / $132.30
| Facility | 26 | $60.32 | $78.56 | $132.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.55 / $317.86 / $436.33
| Professional | | $196.55 | $317.86 | $436.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.88 / $66.01 / $136.12
| Professional | 26 | $55.88 | $66.01 | $136.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $136.80 / $240.00 / $358.73
| Professional | TC | $136.80 | $240.00 | $358.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.26 / $73.26 / $73.26
| Facility | 26 | $73.26 | $73.26 | $73.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.26 / $308.89 / $598.25
| Professional | | $211.26 | $308.89 | $598.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.57 / $83.03 / $139.27
| Professional | 26 | $60.57 | $83.03 | $139.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $148.12 / $219.03 / $463.42
| Professional | TC | $148.12 | $219.03 | $463.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.54 / $67.54 / $67.54
| Facility | 26 | $67.54 | $67.54 | $67.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.78 / $406.38 / $651.16
| Professional | | $200.78 | $406.38 | $651.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.19 / $88.68 / $154.77
| Professional | 26 | $54.19 | $88.68 | $154.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $142.69 / $298.20 / $508.00
| Professional | TC | $142.69 | $298.20 | $508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.12 / $327.94 / $553.52
| Professional | | $212.12 | $327.94 | $553.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.81 / $80.91 / $140.74
| Professional | 26 | $59.81 | $80.91 | $140.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $143.81 / $247.95 / $453.01
| Professional | TC | $143.81 | $247.95 | $453.01 |