- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $64.57 / $102.33
| Facility | 26 | $60.26 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $257.04 / $436.52
| Professional | | $173.78 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $61.66 / $100.00
| Professional | 26 | $50.12 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.82 / $190.55 / $331.13
| Professional | TC | $128.82 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $331.13 / $371.54
| Professional | | $269.15 | $331.13 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $85.11 / $102.33
| Professional | 26 | $72.44 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.17 / $239.88 / $269.15
| Professional | TC | $204.17 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $56.23 / $60.26
| Professional | 26 | $39.81 | $56.23 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $245.47 / $524.81
| Professional | | $138.04 | $245.47 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $69.18 / $112.20
| Professional | 26 | $40.74 | $69.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $97.72 / $173.78 / $354.81
| Professional | TC | $97.72 | $173.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $269.15 / $588.84
| Professional | | $165.96 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $64.57 / $97.72
| Professional | 26 | $47.86 | $64.57 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.82 / $190.55 / $489.78
| Professional | TC | $114.82 | $190.55 | $489.78 |