- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.95 / $85.63 / $145.34
| Facility | 26 | $66.95 | $85.63 | $145.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.98 / $287.80 / $596.03
| Professional | | $185.98 | $287.80 | $596.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.34 / $84.58 / $209.88
| Professional | 26 | $59.34 | $84.58 | $209.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.73 / $221.81 / $363.74
| Professional | TC | $119.73 | $221.81 | $363.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.62 / $73.62 / $73.62
| Facility | 26 | $73.62 | $73.62 | $73.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.78 / $270.17 / $561.16
| Professional | | $185.78 | $270.17 | $561.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.93 / $87.05 / $141.00
| Professional | 26 | $63.93 | $87.05 | $141.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $127.73 / $195.17 / $387.00
| Professional | TC | $127.73 | $195.17 | $387.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.84 / $74.84 / $74.84
| Facility | 26 | $74.84 | $74.84 | $74.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.08 / $327.67 / $544.09
| Professional | | $189.08 | $327.67 | $544.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.20 / $91.30 / $158.00
| Professional | 26 | $58.20 | $91.30 | $158.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $124.06 / $231.09 / $388.91
| Professional | TC | $124.06 | $231.09 | $388.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.16 / $282.83 / $460.44
| Professional | | $183.16 | $282.83 | $460.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.13 / $78.48 / $147.80
| Professional | 26 | $60.13 | $78.48 | $147.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $120.93 / $198.60 / $334.50
| Professional | TC | $120.93 | $198.60 | $334.50 |