- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.81 / $122.06 / $233.67
| Facility | 26 | $95.81 | $122.06 | $233.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.54 / $434.02 / $889.93
| Professional | | $329.54 | $434.02 | $889.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.53 / $101.98 / $250.63
| Professional | 26 | $84.53 | $101.98 | $250.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $240.52 / $316.17 / $552.49
| Professional | TC | $240.52 | $316.17 | $552.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $106.55 / $106.55 / $106.55
| Facility | 26 | $106.55 | $106.55 | $106.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.22 / $430.87 / $922.78
| Professional | | $326.22 | $430.87 | $922.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.54 / $121.77 / $228.88
| Professional | 26 | $91.54 | $121.77 | $228.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $231.20 / $315.18 / $711.78
| Professional | TC | $231.20 | $315.18 | $711.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.46 / $108.46 / $108.46
| Facility | 26 | $108.46 | $108.46 | $108.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.02 / $533.32 / $858.36
| Professional | | $327.02 | $533.32 | $858.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.86 / $135.18 / $225.40
| Professional | 26 | $84.86 | $135.18 | $225.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.96 / $387.13 / $665.32
| Professional | TC | $234.96 | $387.13 | $665.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.75 / $447.80 / $761.18
| Professional | | $325.75 | $447.80 | $761.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.60 / $119.62 / $214.99
| Professional | 26 | $88.60 | $119.62 | $214.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.45 / $329.55 / $556.15
| Professional | TC | $234.45 | $329.55 | $556.15 |