- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.57 / $53.58 / $58.93
| Facility | 26 | $53.57 | $53.58 | $58.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.40 / $138.81 / $160.31
| Professional | | $134.40 | $138.81 | $160.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.10 / $77.81 / $110.74
| Professional | 26 | $46.10 | $77.81 | $110.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.24 / $90.18 / $107.19
| Professional | TC | $85.24 | $90.18 | $107.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.94 / $164.91 / $284.52
| Professional | | $71.94 | $164.91 | $284.52 |
- 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
- $119.83 / $225.60 / $653.25
| Professional | | $119.83 | $225.60 | $653.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.57 / $73.17 / $237.00
| Professional | 26 | $44.57 | $73.17 | $237.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.26 / $152.00 / $416.30
| Professional | TC | $75.26 | $152.00 | $416.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.10 / $226.10 / $259.48
| Professional | | $226.10 | $226.10 | $259.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.25 / $111.00 / $137.07
| Professional | 26 | $81.25 | $111.00 | $137.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.27 / $188.28 / $333.44
| Professional | | $90.27 | $188.28 | $333.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.83 / $68.89 / $124.50
| Professional | 26 | $31.83 | $68.89 | $124.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $53.34 / $119.62 / $224.28
| Professional | TC | $53.34 | $119.62 | $224.28 |