- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.68 / $58.63 / $82.94
| Facility | 26 | $51.68 | $58.63 | $82.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.82 / $364.22 / $505.16
| Professional | | $293.82 | $364.22 | $505.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.47 / $62.08 / $76.28
| Professional | 26 | $43.47 | $62.08 | $76.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $250.34 / $302.13 / $428.87
| Professional | TC | $250.34 | $302.13 | $428.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.18 / $376.92 / $607.01
| Professional | | $354.18 | $376.92 | $607.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.71 / $74.61 / $96.09
| Professional | 26 | $63.71 | $74.61 | $96.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $285.41 / $326.49 / $510.91
| Professional | TC | $285.41 | $326.49 | $510.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $44.96 / $44.96
| Professional | 26 | $40.00 | $44.96 | $44.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.38 / $319.44 / $721.70
| Professional | | $171.38 | $319.44 | $721.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.68 / $50.11 / $109.23
| Professional | 26 | $30.68 | $50.11 | $109.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $140.69 / $253.91 / $598.67
| Professional | TC | $140.69 | $253.91 | $598.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.64 / $346.96 / $544.00
| Professional | | $286.64 | $346.96 | $544.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.33 / $55.00 / $85.40
| Professional | 26 | $43.33 | $55.00 | $85.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $241.27 / $290.52 / $451.28
| Professional | TC | $241.27 | $290.52 | $451.28 |