- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.10 / $29.39 / $43.06
| Facility | 26 | $25.10 | $29.39 | $43.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.40 / $189.78 / $373.49
| Professional | | $147.40 | $189.78 | $373.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.08 / $26.09 / $53.71
| Professional | 26 | $22.08 | $26.09 | $53.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $124.45 / $160.38 / $303.14
| Professional | TC | $124.45 | $160.38 | $303.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.96 / $26.96 / $26.96
| Facility | 26 | $26.96 | $26.96 | $26.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.33 / $178.98 / $305.20
| Professional | | $152.33 | $178.98 | $305.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.94 / $28.58 / $49.86
| Professional | 26 | $21.94 | $28.58 | $49.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.61 / $158.22 / $283.38
| Professional | TC | $128.61 | $158.22 | $283.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.06 / $27.06 / $27.06
| Facility | 26 | $27.06 | $27.06 | $27.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.63 / $237.43 / $407.00
| Professional | | $156.63 | $237.43 | $407.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.58 / $34.08 / $55.36
| Professional | 26 | $23.58 | $34.08 | $55.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $135.19 / $207.93 / $343.69
| Professional | TC | $135.19 | $207.93 | $343.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.02 / $230.99 / $365.99
| Professional | | $156.02 | $230.99 | $365.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.15 / $30.90 / $52.10
| Professional | 26 | $23.15 | $30.90 | $52.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $135.63 / $198.65 / $317.10
| Professional | TC | $135.63 | $198.65 | $317.10 |