- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $69.18 / $173.78
| Facility | 26 | $47.86 | $69.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $223.87 / $645.65
| Professional | | $131.83 | $223.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $63.10 / $181.97
| Professional | 26 | $43.65 | $63.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.18 / $131.83 / $316.23
| Professional | TC | $83.18 | $131.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Facility | 26 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $239.88 / $478.63
| Professional | | $131.83 | $239.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $67.61 / $123.03
| Professional | 26 | $47.86 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $91.20 / $177.83 / $371.54
| Professional | TC | $91.20 | $177.83 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $61.66 / $151.36
| Facility | 26 | $11.48 | $61.66 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $263.03 / $489.78
| Professional | | $131.83 | $263.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $67.61 / $138.04
| Professional | 26 | $38.90 | $67.61 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.11 / $177.83 / $354.81
| Professional | TC | $85.11 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $213.80 / $389.05
| Professional | | $134.90 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $56.23 / $104.71
| Professional | 26 | $40.74 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $91.20 / $147.91 / $288.40
| Professional | TC | $91.20 | $147.91 | $288.40 |