- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $83.18 / $107.15
| Facility | 26 | $61.66 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $251.19 / $436.52
| Professional | | $190.55 | $251.19 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $64.57 / $109.65
| Professional | 26 | $53.70 | $64.57 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.90 / $173.78 / $323.59
| Professional | TC | $134.90 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Professional | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $45.71 / $63.10
| Professional | 26 | $44.67 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $346.74 / $537.03
| Professional | | $257.04 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $83.18 / $128.82
| Professional | 26 | $64.57 | $83.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $263.03 / $407.38
| Professional | TC | $190.55 | $263.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $380.19 / $741.31
| Professional | | $194.98 | $380.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $81.28 / $144.54
| Professional | 26 | $52.48 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.04 / $288.40 / $575.44
| Professional | TC | $138.04 | $288.40 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $323.59 / $549.54
| Professional | | $213.80 | $323.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $66.07 / $114.82
| Professional | 26 | $53.70 | $66.07 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.36 / $251.19 / $457.09
| Professional | TC | $151.36 | $251.19 | $457.09 |