- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.21 / $59.03 / $190.13
| Facility | 26 | $55.21 | $59.03 | $190.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.38 / $300.82 / $439.25
| Professional | | $211.38 | $300.82 | $439.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.12 / $56.68 / $80.62
| Professional | 26 | $41.12 | $56.68 | $80.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.96 / $245.61 / $366.55
| Professional | TC | $169.96 | $245.61 | $366.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.85 / $46.98 / $49.12
| Professional | 26 | $44.85 | $46.98 | $49.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.88 / $323.39 / $382.15
| Professional | | $274.88 | $323.39 | $382.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.75 / $57.93 / $79.31
| Professional | 26 | $52.75 | $57.93 | $79.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $227.42 / $267.55 / $302.83
| Professional | TC | $227.42 | $267.55 | $302.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $42.14 / $44.74
| Professional | 26 | $40.00 | $42.14 | $44.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.68 / $285.27 / $438.06
| Professional | | $233.68 | $285.27 | $438.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.71 / $55.27 / $81.34
| Professional | 26 | $42.71 | $55.27 | $81.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $189.81 / $235.00 / $374.76
| Professional | TC | $189.81 | $235.00 | $374.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.65 / $299.11 / $491.20
| Professional | | $230.65 | $299.11 | $491.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.45 / $49.09 / $85.11
| Professional | 26 | $39.45 | $49.09 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $187.47 / $244.47 / $397.40
| Professional | TC | $187.47 | $244.47 | $397.40 |