- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.03 / $80.65 / $130.36
| Facility | 26 | $59.03 | $80.65 | $130.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.00 / $282.68 / $451.52
| Professional | | $171.00 | $282.68 | $451.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.78 / $61.64 / $135.22
| Professional | 26 | $52.78 | $61.64 | $135.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $116.84 / $217.25 / $299.64
| Professional | TC | $116.84 | $217.25 | $299.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.05 / $65.05 / $65.05
| Facility | 26 | $65.05 | $65.05 | $65.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.42 / $264.08 / $519.08
| Professional | | $184.42 | $264.08 | $519.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.25 / $77.56 / $124.07
| Professional | 26 | $56.25 | $77.56 | $124.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $124.65 / $193.80 / $390.69
| Professional | TC | $124.65 | $193.80 | $390.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.34 / $66.34 / $66.34
| Facility | 26 | $66.34 | $66.34 | $66.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.82 / $341.74 / $541.12
| Professional | | $174.82 | $341.74 | $541.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.57 / $81.99 / $138.40
| Professional | 26 | $51.57 | $81.99 | $138.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $116.74 / $249.17 / $418.90
| Professional | TC | $116.74 | $249.17 | $418.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.02 / $282.42 / $483.96
| Professional | | $182.02 | $282.42 | $483.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.07 / $71.62 / $125.69
| Professional | 26 | $53.07 | $71.62 | $125.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.63 / $202.16 / $361.43
| Professional | TC | $119.63 | $202.16 | $361.43 |