- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.96 / $28.96 / $29.50
| Facility | 26 | $28.96 | $28.96 | $29.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.06 / $112.34 / $141.06
| Professional | | $77.06 | $112.34 | $141.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.91 / $34.47 / $72.23
| Professional | 26 | $25.91 | $34.47 | $72.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.35 / $84.53 / $110.12
| Professional | TC | $41.35 | $84.53 | $110.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.00 / $427.00 / $427.00
| Professional | | $260.00 | $427.00 | $427.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.00 / $128.00 / $128.00
| Professional | 26 | $78.00 | $128.00 | $128.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $299.00 / $299.00 / $299.00
| Professional | TC | $299.00 | $299.00 | $299.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.69 / $148.07 / $234.50
| Professional | | $87.69 | $148.07 | $234.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.03 / $46.98 / $84.26
| Professional | 26 | $31.03 | $46.98 | $84.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.12 / $83.53 / $148.36
| Professional | TC | $46.12 | $83.53 | $148.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.69 / $206.19 / $417.29
| Professional | | $124.69 | $206.19 | $417.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.31 / $62.69 / $117.02
| Professional | 26 | $31.31 | $62.69 | $117.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $92.41 / $130.57 / $300.27
| Professional | TC | $92.41 | $130.57 | $300.27 |