- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $95.50 / $257.04
| Facility | 26 | $52.48 | $95.50 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $977.24
| Professional | | $208.93 | $331.13 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.77 / $114.82 / $676.08
| Professional | 26 | $46.77 | $114.82 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $144.54 / $275.42 / $707.95
| Professional | TC | $144.54 | $275.42 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $758.58
| Professional | | $154.88 | $218.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $56.23 / $151.36
| Professional | 26 | $26.92 | $56.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.82 / $169.82 / $616.60
| Professional | TC | $128.82 | $169.82 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $169.82 / $288.40
| Facility | 26 | $36.31 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $263.03 / $691.83
| Professional | | $107.15 | $263.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $61.66 / $123.03
| Professional | 26 | $30.90 | $61.66 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.86 / $208.93 / $588.84
| Professional | TC | $75.86 | $208.93 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $302.00 / $758.58
| Professional | | $151.36 | $302.00 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $64.57 / $134.90
| Professional | 26 | $37.15 | $64.57 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $107.15 / $245.47 / $630.96
| Professional | TC | $107.15 | $245.47 | $630.96 |