- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.68 / $86.69 / $104.41
| Facility | 26 | $83.68 | $86.69 | $104.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.08 / $158.63 / $264.30
| Professional | | $130.08 | $158.63 | $264.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.13 / $82.39 / $124.21
| Professional | 26 | $72.13 | $82.39 | $124.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.03 / $79.09 / $129.97
| Professional | TC | $55.03 | $79.09 | $129.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.35 / $169.16 / $282.95
| Professional | | $117.35 | $169.16 | $282.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.08 / $99.25 / $157.35
| Professional | 26 | $69.08 | $99.25 | $157.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.47 / $89.14 / $139.06
| Professional | TC | $38.47 | $89.14 | $139.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.04 / $91.04 / $91.04
| Facility | 26 | $91.04 | $91.04 | $91.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.02 / $205.16 / $371.44
| Professional | | $126.02 | $205.16 | $371.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.52 / $112.63 / $194.88
| Professional | 26 | $80.52 | $112.63 | $194.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.53 / $105.25 / $198.42
| Professional | TC | $49.53 | $105.25 | $198.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.34 / $191.93 / $356.15
| Professional | | $132.34 | $191.93 | $356.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.41 / $103.78 / $175.04
| Professional | 26 | $74.41 | $103.78 | $175.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.47 / $102.44 / $180.60
| Professional | TC | $45.47 | $102.44 | $180.60 |