- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $131.83 / $363.08
| Facility | 26 | $77.62 | $131.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $398.11
| Professional | | $134.90 | $186.21 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $89.13 / $204.17
| Professional | 26 | $58.88 | $89.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.54 / $89.13 / $245.47
| Professional | TC | $57.54 | $89.13 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $69.18 / $69.18
| Facility | 26 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $676.08
| Professional | | $154.88 | $281.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $97.72 / $204.17
| Professional | 26 | $69.18 | $97.72 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $70.79 / $162.18 / $512.86
| Professional | TC | $70.79 | $162.18 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $120.23 / $281.84
| Facility | 26 | $22.39 | $120.23 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $295.12 / $724.44
| Professional | | $141.25 | $295.12 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $107.15 / $234.42
| Professional | 26 | $64.57 | $107.15 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $64.57 / $154.88 / $524.81
| Professional | TC | $64.57 | $154.88 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $549.54
| Professional | | $151.36 | $239.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $95.50 / $181.97
| Professional | 26 | $60.26 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.18 / $123.03 / $407.38
| Professional | TC | $69.18 | $123.03 | $407.38 |