- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.51 / $74.73 / $119.79
| Facility | 26 | $57.51 | $74.73 | $119.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.69 / $223.99 / $375.74
| Professional | | $138.69 | $223.99 | $375.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.28 / $60.32 / $136.79
| Professional | 26 | $51.28 | $60.32 | $136.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.18 / $155.88 / $224.97
| Professional | TC | $82.18 | $155.88 | $224.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.24 / $63.24 / $63.24
| Facility | 26 | $63.24 | $63.24 | $63.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.01 / $222.67 / $440.46
| Professional | | $137.01 | $222.67 | $440.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.81 / $75.43 / $121.51
| Professional | 26 | $54.81 | $75.43 | $121.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.47 / $136.75 / $302.24
| Professional | TC | $81.47 | $136.75 | $302.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.44 / $64.44 / $64.44
| Facility | 26 | $64.44 | $64.44 | $64.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.09 / $263.30 / $441.98
| Professional | | $135.09 | $263.30 | $441.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.11 / $78.81 / $139.40
| Professional | 26 | $50.11 | $78.81 | $139.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.38 / $166.19 / $318.00
| Professional | TC | $81.38 | $166.19 | $318.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.09 / $213.11 / $377.47
| Professional | | $135.09 | $213.11 | $377.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.84 / $69.81 / $124.93
| Professional | 26 | $51.84 | $69.81 | $124.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.50 / $133.03 / $259.56
| Professional | TC | $81.50 | $133.03 | $259.56 |