- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.47 / $43.47 / $44.26
| Facility | 26 | $43.47 | $43.47 | $44.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.82 / $199.82 / $223.81
| Professional | | $199.82 | $199.82 | $223.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.47 / $43.47 / $46.84
| Professional | 26 | $43.47 | $43.47 | $46.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $156.36 / $156.36 / $176.96
| Professional | TC | $156.36 | $156.36 | $176.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.00 / $544.00 / $893.00
| Professional | | $544.00 | $544.00 | $893.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $115.00 / $115.00 / $189.00
| Professional | 26 | $115.00 | $115.00 | $189.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $429.00 / $429.00 / $704.00
| Professional | TC | $429.00 | $429.00 | $704.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.74 / $310.74 / $644.02
| Professional | | $310.74 | $310.74 | $644.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.62 / $63.62 / $125.51
| Professional | 26 | $63.62 | $63.62 | $125.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $247.12 / $247.12 / $518.51
| Professional | TC | $247.12 | $247.12 | $518.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.29 / $453.44 / $737.00
| Professional | | $214.29 | $453.44 | $737.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.88 / $84.94 / $153.99
| Professional | 26 | $41.88 | $84.94 | $153.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $172.41 / $308.39 / $583.01
| Professional | TC | $172.41 | $308.39 | $583.01 |