- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.06 / $60.79 / $177.39
| Facility | 26 | $51.06 | $60.79 | $177.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.18 / $156.21 / $239.65
| Professional | | $112.18 | $156.21 | $239.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.72 / $53.58 / $79.25
| Professional | 26 | $35.72 | $53.58 | $79.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $77.33 / $103.49 / $172.26
| Professional | TC | $77.33 | $103.49 | $172.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.42 / $214.42 / $214.42
| Professional | | $214.42 | $214.42 | $214.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.40 / $189.35 / $257.92
| Professional | | $149.40 | $189.35 | $257.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.37 / $62.71 / $87.80
| Professional | 26 | $52.37 | $62.71 | $87.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $97.01 / $126.64 / $167.65
| Professional | TC | $97.01 | $126.64 | $167.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.93 / $39.93 / $40.34
| Professional | 26 | $39.93 | $39.93 | $40.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.07 / $179.76 / $287.01
| Professional | | $125.07 | $179.76 | $287.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.96 / $59.63 / $93.85
| Professional | 26 | $43.96 | $59.63 | $93.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $86.90 / $118.50 / $190.90
| Professional | TC | $86.90 | $118.50 | $190.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.10 / $163.50 / $260.88
| Professional | | $118.10 | $163.50 | $260.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.26 / $53.79 / $88.72
| Professional | 26 | $39.26 | $53.79 | $88.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $76.34 / $103.48 / $182.40
| Professional | TC | $76.34 | $103.48 | $182.40 |