- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $74.13 / $102.33
| Facility | 26 | $67.61 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $218.78 / $426.58
| Professional | | $169.82 | $218.78 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $77.62 / $186.21
| Professional | 26 | $53.70 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $109.65 / $147.91 / $302.00
| Professional | TC | $109.65 | $147.91 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $47.86 / $79.43
| Professional | 26 | $42.66 | $47.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $302.00 / $467.74
| Professional | | $239.88 | $302.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $79.43 / $123.03
| Professional | 26 | $63.10 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.82 / $223.87 / $354.81
| Professional | TC | $169.82 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $323.59 / $616.60
| Professional | | $165.96 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $77.62 / $138.04
| Professional | 26 | $51.29 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $112.20 / $239.88 / $467.74
| Professional | TC | $112.20 | $239.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $275.42 / $457.09
| Professional | | $181.97 | $275.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $64.57 / $109.65
| Professional | 26 | $52.48 | $64.57 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.03 / $199.53 / $363.08
| Professional | TC | $123.03 | $199.53 | $363.08 |