- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.16 / $63.34 / $95.60
| Facility | 26 | $52.16 | $63.34 | $95.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.40 / $160.31 / $303.70
| Professional | | $134.40 | $160.31 | $303.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.10 / $57.78 / $121.02
| Professional | 26 | $46.10 | $57.78 | $121.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $86.87 / $103.98 / $183.81
| Professional | TC | $86.87 | $103.98 | $183.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.64 / $43.64 / $54.55
| Facility | 26 | $43.64 | $43.64 | $54.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.93 / $162.62 / $301.19
| Professional | | $134.93 | $162.62 | $301.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.99 / $58.15 / $105.83
| Professional | 26 | $48.99 | $58.15 | $105.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $86.26 / $107.79 / $205.84
| Professional | TC | $86.26 | $107.79 | $205.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.64 / $58.64 / $58.64
| Facility | 26 | $58.64 | $58.64 | $58.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.87 / $201.41 / $330.82
| Professional | | $128.87 | $201.41 | $330.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.52 / $70.62 / $118.95
| Professional | 26 | $45.52 | $70.62 | $118.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.39 / $129.12 / $209.48
| Professional | TC | $82.39 | $129.12 | $209.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.36 / $174.29 / $320.91
| Professional | | $134.36 | $174.29 | $320.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.33 / $62.33 / $118.29
| Professional | 26 | $46.33 | $62.33 | $118.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $87.98 / $114.88 / $206.64
| Professional | TC | $87.98 | $114.88 | $206.64 |