- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.99 / $125.16 / $189.22
| Facility | 26 | $98.99 | $125.16 | $189.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.44 / $464.96 / $660.66
| Professional | | $314.44 | $464.96 | $660.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.34 / $124.36 / $155.65
| Professional | 26 | $83.34 | $124.36 | $155.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $231.66 / $335.00 / $533.85
| Professional | TC | $231.66 | $335.00 | $533.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.21 / $92.21 / $92.21
| Facility | 26 | $92.21 | $92.21 | $92.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.01 / $443.13 / $910.69
| Professional | | $324.01 | $443.13 | $910.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.89 / $101.55 / $177.32
| Professional | 26 | $75.89 | $101.55 | $177.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.19 / $356.00 / $747.25
| Professional | TC | $245.19 | $356.00 | $747.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.41 / $93.41 / $93.41
| Facility | 26 | $93.41 | $93.41 | $93.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.35 / $625.17 / $1,028.94
| Professional | | $319.35 | $625.17 | $1,028.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.89 / $116.59 / $195.15
| Professional | 26 | $72.89 | $116.59 | $195.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.24 / $494.85 / $836.23
| Professional | TC | $245.24 | $494.85 | $836.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.56 / $526.44 / $915.70
| Professional | | $321.56 | $526.44 | $915.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.47 / $99.60 / $177.56
| Professional | 26 | $75.47 | $99.60 | $177.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.06 / $425.29 / $742.24
| Professional | TC | $239.06 | $425.29 | $742.24 |