- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.87 / $125.79 / $125.80
| Facility | 26 | $81.87 | $125.79 | $125.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.00 / $355.82 / $464.99
| Professional | | $171.00 | $355.82 | $464.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.30 / $98.00 / $132.09
| Professional | 26 | $51.30 | $98.00 | $132.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.70 / $230.02 / $310.52
| Professional | TC | $119.70 | $230.02 | $310.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.50 / $82.13 / $98.56
| Professional | 26 | $65.50 | $82.13 | $98.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.70 / $181.87 / $390.20
| Professional | | $120.70 | $181.87 | $390.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.42 / $92.36 / $108.98
| Professional | 26 | $67.42 | $92.36 | $108.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $86.99 / $131.08 / $281.22
| Professional | TC | $86.99 | $131.08 | $281.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.36 / $459.48 / $961.41
| Professional | | $249.36 | $459.48 | $961.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.31 / $115.90 / $262.14
| Professional | 26 | $67.31 | $115.90 | $262.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $182.48 / $330.89 / $701.77
| Professional | TC | $182.48 | $330.89 | $701.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.64 / $347.12 / $663.17
| Professional | | $272.64 | $347.12 | $663.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.00 / $92.36 / $133.87
| Professional | 26 | $72.00 | $92.36 | $133.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $198.68 / $264.89 / $549.42
| Professional | TC | $198.68 | $264.89 | $549.42 |