- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.06 / $29.94 / $38.94
| Facility | 26 | $27.06 | $29.94 | $38.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.90 / $260.48 / $366.19
| Professional | | $221.90 | $260.48 | $366.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.60 / $28.72 / $40.00
| Professional | 26 | $20.60 | $28.72 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $201.28 / $231.76 / $330.38
| Professional | TC | $201.28 | $231.76 | $330.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.27 / $24.27 / $24.27
| Professional | 26 | $24.27 | $24.27 | $24.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.63 / $266.30 / $424.07
| Professional | | $250.63 | $266.30 | $424.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.69 / $34.52 / $45.21
| Professional | 26 | $29.69 | $34.52 | $45.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.84 / $250.32 / $378.85
| Professional | TC | $218.84 | $250.32 | $378.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.10 / $21.10 / $40.00
| Professional | 26 | $21.10 | $21.10 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.88 / $229.70 / $464.11
| Professional | | $122.88 | $229.70 | $464.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.40 / $23.53 / $49.41
| Professional | 26 | $14.40 | $23.53 | $49.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $108.48 / $193.51 / $414.70
| Professional | TC | $108.48 | $193.51 | $414.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.26 / $252.91 / $405.22
| Professional | | $200.26 | $252.91 | $405.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.68 / $24.90 / $44.86
| Professional | 26 | $19.68 | $24.90 | $44.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $178.86 / $222.67 / $346.16
| Professional | TC | $178.86 | $222.67 | $346.16 |