- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.44 / $53.44 / $54.41
| Facility | 26 | $53.44 | $53.44 | $54.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.01 / $170.01 / $178.71
| Professional | | $170.01 | $170.01 | $178.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.44 / $53.44 / $57.17
| Professional | 26 | $53.44 | $53.44 | $57.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $116.57 / $116.57 / $121.54
| Professional | TC | $116.57 | $116.57 | $121.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.00 / $444.00 / $729.00
| Professional | | $444.00 | $444.00 | $729.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.00 / $141.00 / $231.00
| Professional | 26 | $141.00 | $141.00 | $231.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $303.00 / $303.00 / $498.00
| Professional | TC | $303.00 | $303.00 | $498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.72 / $234.72 / $473.75
| Professional | | $234.72 | $234.72 | $473.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.16 / $79.16 / $153.22
| Professional | 26 | $79.16 | $79.16 | $153.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $155.55 / $155.55 / $320.52
| Professional | TC | $155.55 | $155.55 | $320.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.63 / $313.70 / $547.83
| Professional | | $153.63 | $313.70 | $547.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.54 / $103.54 / $184.81
| Professional | 26 | $50.54 | $103.54 | $184.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $103.10 / $210.17 / $367.02
| Professional | TC | $103.10 | $210.17 | $367.02 |