- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.61 / $235.79 / $470.55
| Facility | 26 | $46.61 | $235.79 | $470.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.44 / $172.69 / $468.00
| Professional | | $93.44 | $172.69 | $468.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.96 / $72.50 / $192.00
| Professional | 26 | $37.96 | $72.50 | $192.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.82 / $69.94 / $137.27
| Professional | TC | $56.82 | $69.94 | $137.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.25 / $151.22 / $226.16
| Professional | | $112.25 | $151.22 | $226.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.82 / $57.34 / $85.81
| Professional | 26 | $43.82 | $57.34 | $85.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.70 / $93.53 / $138.01
| Professional | TC | $67.70 | $93.53 | $138.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $65.65 / $98.98
| Professional | | $32.34 | $65.65 | $98.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.33 / $198.33 / $198.33
| Facility | 26 | $198.33 | $198.33 | $198.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.58 / $201.76 / $235.74
| Professional | | $163.58 | $201.76 | $235.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.49 / $75.36 / $94.24
| Professional | 26 | $59.49 | $75.36 | $94.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $104.10 / $124.53 / $143.85
| Professional | TC | $104.10 | $124.53 | $143.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.37 / $117.08 / $189.96
| Professional | | $109.37 | $117.08 | $189.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.85 / $43.31 / $69.86
| Professional | 26 | $41.85 | $43.31 | $69.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.23 / $73.56 / $118.50
| Professional | TC | $68.23 | $73.56 | $118.50 |