- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.18 / $51.18 / $52.15
| Facility | 26 | $51.18 | $51.18 | $52.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.13 / $196.78 / $294.07
| Professional | | $141.13 | $196.78 | $294.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.57 / $54.08 / $72.02
| Professional | 26 | $48.57 | $54.08 | $72.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $90.95 / $131.16 / $239.98
| Professional | TC | $90.95 | $131.16 | $239.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.00 / $643.00 / $643.00
| Professional | | $392.00 | $643.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $137.00 / $224.00 / $224.00
| Professional | 26 | $137.00 | $224.00 | $224.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $255.00 / $419.00 / $419.00
| Professional | TC | $255.00 | $419.00 | $419.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.74 / $294.17 / $463.86
| Professional | | $211.74 | $294.17 | $463.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.62 / $83.85 / $146.80
| Professional | 26 | $61.62 | $83.85 | $146.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $136.29 / $204.44 / $364.52
| Professional | TC | $136.29 | $204.44 | $364.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.62 / $319.70 / $762.30
| Professional | | $218.62 | $319.70 | $762.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.65 / $101.40 / $173.80
| Professional | 26 | $47.65 | $101.40 | $173.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $167.44 / $208.27 / $588.50
| Professional | TC | $167.44 | $208.27 | $588.50 |