- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $107.15 / $269.15
| Facility | 26 | $57.54 | $107.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $724.44
| Professional | | $354.81 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $64.57 / $107.15
| Professional | 26 | $52.48 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $28.18 / $95.50 / $95.50
| Professional | 52 | $28.18 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $302.00 / $371.54 / $602.56
| Professional | TC | $302.00 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $954.99
| Professional | | $354.81 | $478.63 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $72.44 / $154.88
| Professional | 26 | $53.70 | $72.44 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $316.23 / $407.38 / $812.83
| Professional | TC | $316.23 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $75.86 / $204.17
| Facility | 26 | $14.13 | $75.86 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $660.69 / $1,096.48
| Professional | | $407.38 | $660.69 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $97.72 / $158.49
| Professional | 26 | $60.26 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $346.74 / $562.34 / $954.99
| Professional | TC | $346.74 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $954.99
| Professional | | $363.08 | $537.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $79.43 / $141.25
| Professional | 26 | $53.70 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $309.03 / $457.09 / $812.83
| Professional | TC | $309.03 | $457.09 | $812.83 |