- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.15 / $78.37 / $132.66
| Facility | 26 | $61.15 | $78.37 | $132.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.91 / $312.88 / $559.88
| Professional | | $229.91 | $312.88 | $559.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.86 / $64.76 / $175.49
| Professional | 26 | $54.86 | $64.76 | $175.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $168.65 / $248.90 / $408.74
| Professional | TC | $168.65 | $248.90 | $408.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.58 / $67.58 / $67.58
| Facility | 26 | $67.58 | $67.58 | $67.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.58 / $305.55 / $633.54
| Professional | | $235.58 | $305.55 | $633.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.59 / $80.56 / $130.66
| Professional | 26 | $58.59 | $80.56 | $130.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $170.50 / $221.99 / $508.05
| Professional | TC | $170.50 | $221.99 | $508.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.05 / $69.05 / $69.05
| Facility | 26 | $69.05 | $69.05 | $69.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.18 / $375.00 / $616.90
| Professional | | $224.18 | $375.00 | $616.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.68 / $84.19 / $146.38
| Professional | 26 | $53.68 | $84.19 | $146.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.29 / $284.45 / $470.28
| Professional | TC | $169.29 | $284.45 | $470.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.53 / $316.89 / $535.01
| Professional | | $218.53 | $316.89 | $535.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.80 / $78.39 / $143.41
| Professional | 26 | $55.80 | $78.39 | $143.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $157.97 / $249.43 / $420.31
| Professional | TC | $157.97 | $249.43 | $420.31 |