- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.08 / $126.05 / $238.06
| Facility | 26 | $104.08 | $126.05 | $238.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.76 / $197.12 / $435.48
| Professional | | $131.76 | $197.12 | $435.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.92 / $108.60 / $266.37
| Professional | 26 | $90.92 | $108.60 | $266.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.69 / $67.28 / $111.36
| Professional | TC | $28.69 | $67.28 | $111.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.20 / $210.67 / $445.59
| Professional | | $134.20 | $210.67 | $445.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.66 / $132.02 / $212.60
| Professional | 26 | $103.66 | $132.02 | $212.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.82 / $54.66 / $184.54
| Professional | TC | $32.82 | $54.66 | $184.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.50 / $121.50 / $121.50
| Facility | 26 | $121.50 | $121.50 | $121.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.94 / $255.33 / $517.29
| Professional | | $148.94 | $255.33 | $517.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.82 / $149.15 / $245.28
| Professional | 26 | $100.82 | $149.15 | $245.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.74 / $63.98 / $309.52
| Professional | TC | $35.74 | $63.98 | $309.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.78 / $217.50 / $467.92
| Professional | | $136.78 | $217.50 | $467.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.18 / $132.96 / $221.20
| Professional | 26 | $102.18 | $132.96 | $221.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.98 / $47.66 / $313.16
| Professional | TC | $25.98 | $47.66 | $313.16 |