- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.08 / $45.08 / $45.94
| Facility | 26 | $45.08 | $45.08 | $45.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.35 / $172.01 / $280.77
| Professional | | $123.35 | $172.01 | $280.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.14 / $49.32 / $115.98
| Professional | 26 | $44.14 | $49.32 | $115.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $78.86 / $113.74 / $231.46
| Professional | TC | $78.86 | $113.74 | $231.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.00 / $564.00 / $564.00
| Professional | | $344.00 | $564.00 | $564.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $120.00 / $196.00 / $196.00
| Professional | 26 | $120.00 | $196.00 | $196.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $224.00 / $368.00 / $368.00
| Professional | TC | $224.00 | $368.00 | $368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.67 / $280.16 / $505.89
| Professional | | $211.67 | $280.16 | $505.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.17 / $75.86 / $130.31
| Professional | 26 | $63.17 | $75.86 | $130.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $137.80 / $193.64 / $373.71
| Professional | TC | $137.80 | $193.64 | $373.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.86 / $305.07 / $768.90
| Professional | | $214.86 | $305.07 | $768.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.32 / $90.00 / $164.99
| Professional | 26 | $43.32 | $90.00 | $164.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $158.84 / $206.16 / $589.60
| Professional | TC | $158.84 | $206.16 | $589.60 |