- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $144.54 / $199.53 / $371.54
| Facility | 26 | $144.54 | $199.53 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $295.12 / $870.96
| Professional | | $229.09 | $295.12 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $169.82 / $446.68
| Professional | 26 | $141.25 | $169.82 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.18 / $104.71 / $177.83
| Professional | TC | $83.18 | $104.71 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $275.42 / $501.19
| Professional | | $199.53 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $123.03 / $173.78 / $309.03
| Professional | 26 | $123.03 | $173.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.43 / $107.15 / $208.93
| Professional | TC | $79.43 | $107.15 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $199.53 / $549.54
| Facility | 26 | $37.15 | $199.53 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $776.25
| Professional | | $245.47 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $234.42 / $478.63
| Professional | 26 | $154.88 | $234.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $93.33 / $147.91 / $288.40
| Professional | TC | $93.33 | $147.91 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $575.44
| Professional | | $223.87 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $134.90 / $194.98 / $354.81
| Professional | 26 | $134.90 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $89.13 / $125.89 / $223.87
| Professional | TC | $89.13 | $125.89 | $223.87 |