- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.00 / $75.42 / $137.61
| Facility | 26 | $59.00 | $75.42 | $137.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.70 / $162.08 / $719.13
| Professional | | $117.70 | $162.08 | $719.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.67 / $85.66 / $637.80
| Professional | 26 | $53.67 | $85.66 | $637.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.34 / $91.52 / $150.81
| Professional | TC | $60.34 | $91.52 | $150.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.92 / $174.57 / $283.69
| Professional | | $122.92 | $174.57 | $283.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.79 / $78.82 / $122.67
| Professional | 26 | $58.79 | $78.82 | $122.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.19 / $96.56 / $175.29
| Professional | TC | $65.19 | $96.56 | $175.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.78 / $68.78 / $68.78
| Facility | 26 | $68.78 | $68.78 | $68.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.69 / $198.62 / $339.76
| Professional | | $140.69 | $198.62 | $339.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.97 / $86.29 / $138.21
| Professional | 26 | $58.97 | $86.29 | $138.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.38 / $114.72 / $188.25
| Professional | TC | $74.38 | $114.72 | $188.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.87 / $182.47 / $285.26
| Professional | | $128.87 | $182.47 | $285.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.73 / $77.86 / $125.60
| Professional | 26 | $59.73 | $77.86 | $125.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.48 / $101.93 / $160.99
| Professional | TC | $67.48 | $101.93 | $160.99 |