- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.21 / $42.82 / $42.83
| Facility | 26 | $38.21 | $42.82 | $42.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $123.30 / $146.05
| Professional | | $91.20 | $123.30 | $146.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.39 / $42.83 / $52.63
| Professional | 26 | $33.39 | $42.83 | $52.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.80 / $80.47 / $95.64
| Professional | TC | $57.80 | $80.47 | $95.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.69 / $173.55 / $204.79
| Professional | | $126.69 | $173.55 | $204.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.17 / $60.50 / $71.39
| Professional | 26 | $44.17 | $60.50 | $71.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.53 / $113.05 / $133.40
| Professional | TC | $82.53 | $113.05 | $133.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.52 / $127.20 / $237.78
| Professional | | $92.52 | $127.20 | $237.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.76 / $47.34 / $99.74
| Professional | 26 | $34.76 | $47.34 | $99.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.47 / $85.75 / $151.78
| Professional | TC | $50.47 | $85.75 | $151.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.19 / $103.04 / $153.19
| Professional | | $77.19 | $103.04 | $153.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.14 / $42.08 / $55.12
| Professional | 26 | $32.14 | $42.08 | $55.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.28 / $59.86 / $97.62
| Professional | TC | $46.28 | $59.86 | $97.62 |