- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.23 / $49.46 / $85.30
| Facility | 26 | $31.23 | $49.46 | $85.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.71 / $193.87 / $431.45
| Professional | | $175.71 | $193.87 | $431.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.91 / $37.40 / $85.30
| Professional | 26 | $23.91 | $37.40 | $85.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $146.29 / $169.96 / $346.15
| Professional | TC | $146.29 | $169.96 | $346.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.58 / $317.58 / $317.58
| Professional | | $317.58 | $317.58 | $317.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.34 / $296.88 / $418.88
| Professional | | $185.34 | $296.88 | $418.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.03 / $45.60 / $68.34
| Professional | 26 | $30.03 | $45.60 | $68.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $152.79 / $247.40 / $375.00
| Professional | TC | $152.79 | $247.40 | $375.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.53 / $87.53 / $169.56
| Facility | 26 | $87.53 | $87.53 | $169.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.40 / $307.76 / $1,546.49
| Professional | | $210.40 | $307.76 | $1,546.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.35 / $50.89 / $391.31
| Professional | 26 | $28.35 | $50.89 | $391.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.26 / $270.27 / $1,417.87
| Professional | TC | $169.26 | $270.27 | $1,417.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.40 / $274.12 / $495.14
| Professional | | $210.40 | $274.12 | $495.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.40 / $42.04 / $70.62
| Professional | 26 | $27.40 | $42.04 | $70.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.26 / $234.89 / $339.51
| Professional | TC | $169.26 | $234.89 | $339.51 |