- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.20 / $81.52 / $138.04
| Facility | 26 | $62.20 | $81.52 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.57 / $286.64 / $518.11
| Professional | | $215.57 | $286.64 | $518.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.95 / $62.06 / $94.60
| Professional | 26 | $52.95 | $62.06 | $94.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $153.52 / $216.02 / $455.81
| Professional | TC | $153.52 | $216.02 | $455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.63 / $301.66 / $502.86
| Professional | | $214.63 | $301.66 | $502.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.21 / $73.29 / $119.99
| Professional | 26 | $57.21 | $73.29 | $119.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $157.16 / $223.68 / $442.46
| Professional | TC | $157.16 | $223.68 | $442.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.72 / $71.72 / $71.72
| Facility | 26 | $71.72 | $71.72 | $71.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.57 / $405.27 / $755.36
| Professional | | $230.57 | $405.27 | $755.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.24 / $83.95 / $139.31
| Professional | 26 | $55.24 | $83.95 | $139.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $166.51 / $296.17 / $649.61
| Professional | TC | $166.51 | $296.17 | $649.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.27 / $361.35 / $704.79
| Professional | | $208.27 | $361.35 | $704.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.66 / $71.93 / $134.86
| Professional | 26 | $52.66 | $71.93 | $134.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $150.55 / $256.05 / $583.27
| Professional | TC | $150.55 | $256.05 | $583.27 |