- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.76 / $58.60 / $103.19
| Facility | 26 | $47.76 | $58.60 | $103.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.39 / $311.00 / $541.27
| Professional | | $276.39 | $311.00 | $541.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.47 / $50.61 / $109.88
| Professional | 26 | $43.47 | $50.61 | $109.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $231.62 / $266.31 / $466.02
| Professional | TC | $231.62 | $266.31 | $466.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.08 / $355.77 / $602.15
| Professional | | $297.08 | $355.77 | $602.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.75 / $60.44 / $97.22
| Professional | 26 | $46.75 | $60.44 | $97.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $249.02 / $311.09 / $504.75
| Professional | TC | $249.02 | $311.09 | $504.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.82 / $56.82 / $56.82
| Facility | 26 | $56.82 | $56.82 | $56.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.56 / $473.98 / $793.63
| Professional | | $326.56 | $473.98 | $793.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.79 / $72.05 / $119.26
| Professional | 26 | $53.79 | $72.05 | $119.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $273.02 / $398.03 / $669.71
| Professional | TC | $273.02 | $398.03 | $669.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.64 / $376.44 / $693.06
| Professional | | $292.64 | $376.44 | $693.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $60.04 / $112.94
| Professional | 26 | $45.71 | $60.04 | $112.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $246.94 / $319.58 / $581.34
| Professional | TC | $246.94 | $319.58 | $581.34 |