- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.55 / $31.55 / $32.15
| Facility | 26 | $31.55 | $31.55 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.00 / $142.04 / $243.51
| Professional | | $92.00 | $142.04 | $243.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.91 / $37.17 / $173.85
| Professional | 26 | $27.91 | $37.17 | $173.85 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $45.66 / $71.02 / $75.03
| Professional | 52 | $45.66 | $71.02 | $75.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $64.92 / $101.14 / $173.66
| Professional | TC | $64.92 | $101.14 | $173.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.00 / $507.00 / $507.00
| Professional | | $309.00 | $507.00 | $507.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.00 / $139.00 / $139.00
| Professional | 26 | $85.00 | $139.00 | $139.00 |
- 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
- $102.47 / $189.98 / $347.71
| Professional | | $102.47 | $189.98 | $347.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.82 / $51.25 / $91.38
| Professional | 26 | $32.82 | $51.25 | $91.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $73.89 / $127.53 / $201.11
| Professional | TC | $73.89 | $127.53 | $201.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.44 / $241.69 / $419.90
| Professional | | $122.44 | $241.69 | $419.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.70 / $68.26 / $123.50
| Professional | 26 | $33.70 | $68.26 | $123.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $91.39 / $173.43 / $296.39
| Professional | TC | $91.39 | $173.43 | $296.39 |