- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.96 / $81.77 / $129.26
| Facility | 26 | $57.96 | $81.77 | $129.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.00 / $263.67 / $709.48
| Professional | | $188.00 | $263.67 | $709.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.40 / $92.49 / $257.12
| Professional | 26 | $63.40 | $92.49 | $257.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $118.51 / $169.02 / $452.37
| Professional | TC | $118.51 | $169.02 | $452.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.72 / $149.47 / $249.68
| Professional | | $115.72 | $149.47 | $249.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.63 / $53.39 / $85.70
| Professional | 26 | $40.63 | $53.39 | $85.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.45 / $100.65 / $173.19
| Professional | TC | $72.45 | $100.65 | $173.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.19 / $147.20 / $294.01
| Facility | 26 | $114.19 | $147.20 | $294.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.20 / $240.11 / $350.03
| Professional | | $194.20 | $240.11 | $350.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.09 / $87.47 / $129.93
| Professional | 26 | $72.09 | $87.47 | $129.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $122.11 / $146.31 / $220.10
| Professional | TC | $122.11 | $146.31 | $220.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.42 / $166.68 / $278.67
| Professional | | $110.42 | $166.68 | $278.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.57 / $50.96 / $90.56
| Professional | 26 | $37.57 | $50.96 | $90.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.13 / $110.84 / $185.54
| Professional | TC | $68.13 | $110.84 | $185.54 |