- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.67 / $74.55 / $134.15
| Facility | 26 | $61.67 | $74.55 | $134.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.89 / $333.26 / $612.50
| Professional | | $281.89 | $333.26 | $612.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.32 / $64.81 / $137.41
| Professional | 26 | $56.32 | $64.81 | $137.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $225.81 / $260.41 / $457.83
| Professional | TC | $225.81 | $260.41 | $457.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.32 / $377.79 / $585.21
| Professional | | $278.32 | $377.79 | $585.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.92 / $78.17 / $126.37
| Professional | 26 | $61.92 | $78.17 | $126.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.41 / $302.36 / $470.43
| Professional | TC | $223.41 | $302.36 | $470.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.06 / $73.06 / $73.06
| Facility | 26 | $73.06 | $73.06 | $73.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.99 / $463.38 / $760.18
| Professional | | $310.99 | $463.38 | $760.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.51 / $92.18 / $151.65
| Professional | 26 | $68.51 | $92.18 | $151.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $246.22 / $374.00 / $621.09
| Professional | TC | $246.22 | $374.00 | $621.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.36 / $417.05 / $707.68
| Professional | | $302.36 | $417.05 | $707.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.61 / $87.99 / $150.51
| Professional | 26 | $60.61 | $87.99 | $150.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $237.12 / $325.72 / $573.20
| Professional | TC | $237.12 | $325.72 | $573.20 |