- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.33 / $81.33 / $82.81
| Facility | 26 | $81.33 | $81.33 | $82.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.09 / $333.04 / $490.99
| Professional | | $239.09 | $333.04 | $490.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.34 / $87.04 / $114.21
| Professional | 26 | $78.34 | $87.04 | $114.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $159.53 / $218.84 / $403.94
| Professional | TC | $159.53 | $218.84 | $403.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.00 / $1,334.00 / $1,334.00
| Professional | | $812.00 | $1,334.00 | $1,334.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $216.00 / $355.00 / $355.00
| Professional | 26 | $216.00 | $355.00 | $355.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $596.00 / $979.00 / $979.00
| Professional | TC | $596.00 | $979.00 | $979.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.71 / $596.55 / $1,099.01
| Professional | | $397.71 | $596.55 | $1,099.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.63 / $150.50 / $259.48
| Professional | 26 | $99.63 | $150.50 | $259.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $277.23 / $436.61 / $825.74
| Professional | TC | $277.23 | $436.61 | $825.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.87 / $599.91 / $1,455.30
| Professional | | $390.87 | $599.91 | $1,455.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.40 / $160.99 / $281.62
| Professional | 26 | $77.40 | $160.99 | $281.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $311.32 / $455.52 / $1,173.68
| Professional | TC | $311.32 | $455.52 | $1,173.68 |