- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.03 / $44.75 / $98.27
| Facility | 26 | $41.03 | $44.75 | $98.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.32 / $281.60 / $618.36
| Professional | | $267.32 | $281.60 | $618.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.47 / $50.69 / $98.27
| Professional | 26 | $43.47 | $50.69 | $98.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.84 / $236.87 / $520.09
| Professional | TC | $223.84 | $236.87 | $520.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.08 / $109.08 / $109.08
| Professional | 26 | $109.08 | $109.08 | $109.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.00 / $487.00 / $487.00
| Professional | | $487.00 | $487.00 | $487.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.39 / $448.76 / $744.57
| Professional | | $315.39 | $448.76 | $744.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.40 / $79.44 / $114.50
| Professional | 26 | $48.40 | $79.44 | $114.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $267.67 / $369.32 / $627.28
| Professional | TC | $267.67 | $369.32 | $627.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.70 / $339.77 / $633.53
| Professional | | $249.70 | $339.77 | $633.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.29 / $51.61 / $112.15
| Professional | 26 | $41.29 | $51.61 | $112.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $211.80 / $303.02 / $521.38
| Professional | TC | $211.80 | $303.02 | $521.38 |