- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.63 / $48.17 / $91.56
| Facility | 26 | $35.63 | $48.17 | $91.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.87 / $256.76 / $477.06
| Professional | | $251.87 | $256.76 | $477.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.37 / $33.17 / $35.63
| Professional | 26 | $31.37 | $33.17 | $35.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.71 / $218.71 / $271.52
| Professional | TC | $218.71 | $218.71 | $271.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.10 / $266.60 / $416.03
| Professional | | $170.10 | $266.60 | $416.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.84 / $38.84 / $46.59
| Professional | 26 | $23.84 | $38.84 | $46.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $146.26 / $227.76 / $369.44
| Professional | TC | $146.26 | $227.76 | $369.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.07 / $291.41 / $757.85
| Professional | | $180.07 | $291.41 | $757.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.54 / $46.08 / $86.76
| Professional | 26 | $30.54 | $46.08 | $86.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.84 / $263.72 / $671.09
| Professional | TC | $194.84 | $263.72 | $671.09 |