- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.80 / $64.00 / $78.87
| Facility | 26 | $48.80 | $64.00 | $78.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.26 / $264.64 / $320.00
| Professional | | $148.26 | $264.64 | $320.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.14 / $60.00 / $100.21
| Professional | 26 | $44.14 | $60.00 | $100.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $90.69 / $201.03 / $240.00
| Professional | TC | $90.69 | $201.03 | $240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.82 / $126.82 / $126.82
| Professional | | $126.82 | $126.82 | $126.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.45 / $46.72 / $86.89
| Professional | 26 | $40.45 | $46.72 | $86.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.41 / $215.06 / $314.76
| Professional | | $175.41 | $215.06 | $314.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.32 / $76.63 / $91.58
| Professional | 26 | $55.32 | $76.63 | $91.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $120.09 / $143.56 / $223.17
| Professional | TC | $120.09 | $143.56 | $223.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.78 / $42.78 / $45.86
| Professional | 26 | $42.78 | $42.78 | $45.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.40 / $161.59 / $336.82
| Professional | | $81.40 | $161.59 | $336.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.71 / $55.85 / $95.02
| Professional | 26 | $30.71 | $55.85 | $95.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.69 / $101.04 / $251.26
| Professional | TC | $50.69 | $101.04 | $251.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.18 / $188.82 / $352.01
| Professional | | $132.18 | $188.82 | $352.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.07 / $54.46 / $90.31
| Professional | 26 | $40.07 | $54.46 | $90.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $88.06 / $118.33 / $223.33
| Professional | TC | $88.06 | $118.33 | $223.33 |