- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.41 / $45.41 / $46.25
| Facility | 26 | $45.41 | $45.41 | $46.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.37 / $300.37 / $338.30
| Professional | | $300.37 | $300.37 | $338.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.41 / $45.41 / $48.23
| Professional | 26 | $45.41 | $45.41 | $48.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $254.96 / $254.96 / $290.07
| Professional | TC | $254.96 | $254.96 | $290.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.00 / $825.00 / $1,355.00
| Professional | | $825.00 | $825.00 | $1,355.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $120.00 / $120.00 / $198.00
| Professional | 26 | $120.00 | $120.00 | $198.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $705.00 / $705.00 / $1,157.00
| Professional | TC | $705.00 | $705.00 | $1,157.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.45 / $469.45 / $967.78
| Professional | | $469.45 | $469.45 | $967.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.98 / $66.98 / $131.22
| Professional | 26 | $66.98 | $66.98 | $131.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $402.47 / $402.47 / $836.56
| Professional | TC | $402.47 | $402.47 | $836.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.42 / $614.41 / $1,142.69
| Professional | | $293.42 | $614.41 | $1,142.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.75 / $88.66 / $156.19
| Professional | 26 | $42.75 | $88.66 | $156.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $260.39 / $508.80 / $918.12
| Professional | TC | $260.39 | $508.80 | $918.12 |