- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $114.82 / $234.42
| Facility | 26 | $81.28 | $114.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $891.25
| Professional | | $354.81 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $104.71 / $338.84
| Professional | 26 | $79.43 | $104.71 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $269.15 / $346.74 / $645.65
| Professional | TC | $269.15 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $446.68 / $831.76
| Professional | | $251.19 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $102.33 / $186.21
| Professional | 26 | $72.44 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $338.84 / $660.69
| Professional | TC | $162.18 | $338.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $109.65 / $295.12
| Facility | 26 | $20.42 | $109.65 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $588.84 / $1,318.26
| Professional | | $316.23 | $588.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $128.82 / $263.03
| Professional | 26 | $83.18 | $128.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $478.63 / $1,096.48
| Professional | TC | $234.42 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $912.01
| Professional | | $295.12 | $446.68 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $104.71 / $194.98
| Professional | 26 | $74.13 | $104.71 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $354.81 / $724.44
| Professional | TC | $218.78 | $354.81 | $724.44 |