- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.06 / $40.06 / $40.88
| Facility | 26 | $40.06 | $40.06 | $40.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.70 / $182.50 / $205.01
| Professional | | $168.70 | $182.50 | $205.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.06 / $43.49 / $75.80
| Professional | 26 | $40.06 | $43.49 | $75.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.63 / $129.21 / $139.01
| Professional | TC | $128.63 | $129.21 | $139.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.91 / $57.91 / $69.50
| Facility | 26 | $57.91 | $57.91 | $69.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.19 / $353.00 / $558.00
| Professional | | $232.19 | $353.00 | $558.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.81 / $83.00 / $132.00
| Professional | 26 | $54.81 | $83.00 | $132.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.38 / $270.00 / $426.00
| Professional | TC | $177.38 | $270.00 | $426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.38 / $89.47 / $775.63
| Professional | | $78.38 | $89.47 | $775.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $29.21 / $184.85
| Professional | 26 | $22.39 | $29.21 | $184.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.00 / $60.26 / $590.78
| Professional | TC | $56.00 | $60.26 | $590.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.13 / $110.44 / $368.12
| Professional | | $95.13 | $110.44 | $368.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.50 / $33.90 / $91.66
| Professional | 26 | $27.50 | $33.90 | $91.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $59.95 / $82.94 / $279.89
| Professional | TC | $59.95 | $82.94 | $279.89 |