- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.60 / $65.62 / $88.94
| Facility | 26 | $57.60 | $65.62 | $88.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.67 / $424.11 / $794.15
| Professional | | $338.67 | $424.11 | $794.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.15 / $58.59 / $145.26
| Professional | 26 | $51.15 | $58.59 | $145.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $286.04 / $368.11 / $665.80
| Professional | TC | $286.04 | $368.11 | $665.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.02 / $465.16 / $777.83
| Professional | | $254.02 | $465.16 | $777.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.98 / $67.06 / $112.76
| Professional | 26 | $49.98 | $67.06 | $112.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.04 / $410.00 / $667.79
| Professional | TC | $204.04 | $410.00 | $667.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.88 / $63.88 / $63.88
| Facility | 26 | $63.88 | $63.88 | $63.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.47 / $549.26 / $1,029.22
| Professional | | $275.47 | $549.26 | $1,029.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.66 / $78.84 / $135.19
| Professional | 26 | $55.66 | $78.84 | $135.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $228.02 / $483.77 / $885.83
| Professional | TC | $228.02 | $483.77 | $885.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.91 / $484.21 / $926.58
| Professional | | $251.91 | $484.21 | $926.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.70 / $72.25 / $121.36
| Professional | 26 | $52.70 | $72.25 | $121.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.97 / $420.46 / $759.78
| Professional | TC | $194.97 | $420.46 | $759.78 |