- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $77.62 / $77.62
| Facility | 26 | $51.29 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $302.00 / $575.44
| Professional | | $194.98 | $302.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $97.72 / $162.18
| Professional | 26 | $52.48 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.90 / $218.78 / $426.58
| Professional | TC | $134.90 | $218.78 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $57.54 / $66.07
| Professional | 26 | $40.74 | $57.54 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $288.40 / $338.84
| Professional | | $104.71 | $288.40 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $114.82 / $144.54
| Professional | 26 | $79.43 | $114.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $63.10 / $173.78 / $204.17
| Professional | TC | $63.10 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $630.96
| Professional | | $213.80 | $309.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $81.28 / $162.18
| Professional | 26 | $52.48 | $81.28 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $158.49 / $239.88 / $478.63
| Professional | TC | $158.49 | $239.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $426.58
| Professional | | $181.97 | $245.47 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $57.54 / $85.11
| Professional | 26 | $43.65 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.90 / $186.21 / $346.74
| Professional | TC | $134.90 | $186.21 | $346.74 |