- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.44 / $45.12 / $84.17
| Facility | 26 | $36.44 | $45.12 | $84.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.23 / $259.63 / $494.48
| Professional | | $171.23 | $259.63 | $494.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.73 / $40.40 / $97.29
| Professional | 26 | $30.73 | $40.40 | $97.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $149.47 / $219.41 / $424.89
| Professional | TC | $149.47 | $219.41 | $424.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.07 / $296.89 / $478.59
| Professional | | $239.07 | $296.89 | $478.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.54 / $45.84 / $71.85
| Professional | 26 | $36.54 | $45.84 | $71.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $196.77 / $257.26 / $397.95
| Professional | TC | $196.77 | $257.26 | $397.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.72 / $42.72 / $42.72
| Facility | 26 | $42.72 | $42.72 | $42.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.44 / $315.98 / $577.17
| Professional | | $213.44 | $315.98 | $577.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.46 / $51.42 / $86.76
| Professional | 26 | $35.46 | $51.42 | $86.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.65 / $270.16 / $501.47
| Professional | TC | $173.65 | $270.16 | $501.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.73 / $314.44 / $539.34
| Professional | | $191.73 | $314.44 | $539.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.51 / $45.94 / $84.47
| Professional | 26 | $34.51 | $45.94 | $84.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $163.52 / $269.14 / $461.82
| Professional | TC | $163.52 | $269.14 | $461.82 |