- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $54.95 / $162.18
| Facility | 26 | $33.88 | $54.95 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $794.33
| Professional | | $190.55 | $288.40 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $57.54 / $125.89
| Professional | 26 | $32.36 | $57.54 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $158.49 / $245.47 / $602.56
| Professional | TC | $158.49 | $245.47 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $275.42 / $549.54
| Professional | | $181.97 | $275.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $46.77 / $87.10
| Professional | 26 | $36.31 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.25 / $234.42 / $478.63
| Professional | TC | $141.25 | $234.42 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $51.29 / $154.88
| Facility | 26 | $9.12 | $51.29 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $338.84 / $758.58
| Professional | | $199.53 | $338.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $54.95 / $109.65
| Professional | 26 | $33.88 | $54.95 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $165.96 / $309.03 / $676.08
| Professional | TC | $165.96 | $309.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $588.84
| Professional | | $177.83 | $288.40 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $43.65 / $81.28
| Professional | 26 | $30.90 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $147.91 / $251.19 / $512.86
| Professional | TC | $147.91 | $251.19 | $512.86 |