- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $97.72 / $186.21
| Facility | 26 | $75.86 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $181.97 / $489.78
| Professional | | $125.89 | $181.97 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $89.13 / $229.09
| Professional | 26 | $72.44 | $89.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.48 / $63.10 / $112.20
| Professional | TC | $52.48 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $269.15
| Professional | | $107.15 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $87.10 / $154.88
| Professional | 26 | $63.10 | $87.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.86 / $67.61 / $125.89
| Professional | TC | $47.86 | $67.61 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $100.00 / $275.42
| Facility | 26 | $19.05 | $100.00 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $416.87
| Professional | | $134.90 | $204.17 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $117.49 / $239.88
| Professional | 26 | $77.62 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.54 / $91.20 / $181.97
| Professional | TC | $57.54 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $173.78 / $316.23
| Professional | | $123.03 | $173.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $97.72 / $177.83
| Professional | 26 | $69.18 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.95 / $77.62 / $138.04
| Professional | TC | $54.95 | $77.62 | $138.04 |