- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.84 / $70.27 / $128.18
| Facility | 26 | $59.84 | $70.27 | $128.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.41 / $440.96 / $749.38
| Professional | | $382.41 | $440.96 | $749.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.20 / $63.17 / $103.92
| Professional | 26 | $53.20 | $63.17 | $103.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $326.64 / $380.00 / $658.58
| Professional | TC | $326.64 | $380.00 | $658.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.14 / $473.55 / $770.56
| Professional | | $374.14 | $473.55 | $770.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.02 / $69.77 / $114.50
| Professional | 26 | $51.02 | $69.77 | $114.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $292.73 / $405.98 / $684.32
| Professional | TC | $292.73 | $405.98 | $684.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.81 / $64.81 / $64.81
| Facility | 26 | $64.81 | $64.81 | $64.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.46 / $629.11 / $1,091.52
| Professional | | $414.46 | $629.11 | $1,091.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.84 / $92.96 / $150.02
| Professional | 26 | $59.84 | $92.96 | $150.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $363.19 / $535.09 / $929.00
| Professional | TC | $363.19 | $535.09 | $929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.18 / $576.69 / $970.69
| Professional | | $388.18 | $576.69 | $970.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.36 / $88.29 / $138.30
| Professional | 26 | $56.36 | $88.29 | $138.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $325.77 / $487.97 / $824.40
| Professional | TC | $325.77 | $487.97 | $824.40 |