- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $97.72 / $281.84
| Facility | 26 | $61.66 | $97.72 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $478.63
| Professional | | $131.83 | $173.78 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $89.13 / $239.88
| Professional | 26 | $54.95 | $89.13 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.07 / $97.72 / $234.42
| Professional | TC | $66.07 | $97.72 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | 26 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $173.78 / $389.05
| Professional | | $91.20 | $173.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $74.13 / $154.88
| Professional | 26 | $44.67 | $74.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.86 / $102.33 / $239.88
| Professional | TC | $47.86 | $102.33 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $91.20 / $218.78
| Facility | 26 | $16.98 | $91.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $208.93 / $426.58
| Professional | | $112.20 | $208.93 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $85.11 / $181.97
| Professional | 26 | $51.29 | $85.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.23 / $112.20 / $302.00
| Professional | TC | $56.23 | $112.20 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $354.81
| Professional | | $120.23 | $173.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $72.44 / $141.25
| Professional | 26 | $47.86 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.26 / $93.33 / $239.88
| Professional | TC | $60.26 | $93.33 | $239.88 |