- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $48.98 / $123.03
| Facility | 26 | $33.11 | $48.98 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $891.25
| Professional | | $239.88 | $323.59 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $52.48 / $131.83
| Professional | 26 | $30.90 | $52.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.17 / $275.42 / $660.69
| Professional | TC | $204.17 | $275.42 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $338.84 / $676.08
| Professional | | $213.80 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $50.12 / $91.20
| Professional | 26 | $35.48 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.78 / $295.12 / $602.56
| Professional | TC | $173.78 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $51.29 / $158.49
| Facility | 26 | $9.12 | $51.29 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $457.09 / $891.25
| Professional | | $239.88 | $457.09 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $57.54 / $107.15
| Professional | 26 | $32.36 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $199.53 / $407.38 / $794.33
| Professional | TC | $199.53 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $724.44
| Professional | | $218.78 | $346.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.62 / $43.65 / $85.11
| Professional | 26 | $31.62 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $186.21 / $302.00 / $630.96
| Professional | TC | $186.21 | $302.00 | $630.96 |