- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.06 / $85.83 / $139.91
| Facility | 26 | $67.06 | $85.83 | $139.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.79 / $366.58 / $649.46
| Professional | | $234.79 | $366.58 | $649.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.39 / $71.20 / $160.97
| Professional | 26 | $60.39 | $71.20 | $160.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.17 / $306.18 / $468.94
| Professional | TC | $169.17 | $306.18 | $468.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.34 / $74.34 / $74.34
| Facility | 26 | $74.34 | $74.34 | $74.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.20 / $333.97 / $740.00
| Professional | | $257.20 | $333.97 | $740.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.28 / $88.78 / $143.28
| Professional | 26 | $64.28 | $88.78 | $143.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.71 / $248.04 / $583.85
| Professional | TC | $188.71 | $248.04 | $583.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.64 / $75.64 / $75.64
| Facility | 26 | $75.64 | $75.64 | $75.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.93 / $438.93 / $747.71
| Professional | | $252.93 | $438.93 | $747.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.94 / $94.10 / $164.43
| Professional | 26 | $58.94 | $94.10 | $164.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $192.44 / $338.85 / $587.59
| Professional | TC | $192.44 | $338.85 | $587.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.52 / $377.90 / $631.66
| Professional | | $247.52 | $377.90 | $631.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.87 / $80.89 / $147.27
| Professional | 26 | $60.87 | $80.89 | $147.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $180.79 / $299.30 / $498.34
| Professional | TC | $180.79 | $299.30 | $498.34 |