- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.66 / $90.07 / $154.88
| Facility | 26 | $68.66 | $90.07 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.87 / $163.04 / $306.35
| Professional | | $137.87 | $163.04 | $306.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.54 / $74.68 / $212.85
| Professional | 26 | $52.54 | $74.68 | $212.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.84 / $99.40 / $178.57
| Professional | TC | $68.84 | $99.40 | $178.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.70 / $60.70 / $60.70
| Facility | 26 | $60.70 | $60.70 | $60.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.44 / $171.17 / $315.43
| Professional | | $132.44 | $171.17 | $315.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.32 / $78.31 / $125.78
| Professional | 26 | $58.32 | $78.31 | $125.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.54 / $87.54 / $202.40
| Professional | TC | $67.54 | $87.54 | $202.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.31 / $79.31 / $79.31
| Facility | 26 | $79.31 | $79.31 | $79.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.00 / $215.40 / $401.06
| Professional | | $128.00 | $215.40 | $401.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.46 / $84.87 / $153.33
| Professional | 26 | $56.46 | $84.87 | $153.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $62.96 / $115.63 / $281.58
| Professional | TC | $62.96 | $115.63 | $281.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.53 / $183.82 / $354.43
| Professional | | $131.53 | $183.82 | $354.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.73 / $82.06 / $149.76
| Professional | 26 | $52.73 | $82.06 | $149.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.81 / $101.33 / $224.15
| Professional | TC | $67.81 | $101.33 | $224.15 |