- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.36 / $94.09 / $131.93
| Facility | 26 | $88.36 | $94.09 | $131.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.94 / $412.07 / $755.46
| Professional | | $346.94 | $412.07 | $755.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.09 / $90.76 / $191.70
| Professional | 26 | $79.09 | $90.76 | $191.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $267.24 / $327.11 / $600.07
| Professional | TC | $267.24 | $327.11 | $600.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.39 / $442.96 / $784.11
| Professional | | $304.39 | $442.96 | $784.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.77 / $104.00 / $166.46
| Professional | 26 | $73.77 | $104.00 | $166.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $222.25 / $358.75 / $635.54
| Professional | TC | $222.25 | $358.75 | $635.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.38 / $96.38 / $96.38
| Facility | 26 | $96.38 | $96.38 | $96.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.70 / $548.62 / $1,011.03
| Professional | | $327.70 | $548.62 | $1,011.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.98 / $121.06 / $206.76
| Professional | 26 | $85.98 | $121.06 | $206.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $242.97 / $452.77 / $822.27
| Professional | TC | $242.97 | $452.77 | $822.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.80 / $500.83 / $909.76
| Professional | | $319.80 | $500.83 | $909.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.88 / $111.16 / $185.82
| Professional | 26 | $80.88 | $111.16 | $185.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $238.69 / $388.46 / $717.68
| Professional | TC | $238.69 | $388.46 | $717.68 |