- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.22 / $26.24 / $46.65
| Facility | 26 | $22.22 | $26.24 | $46.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.75 / $235.36 / $394.16
| Professional | | $199.75 | $235.36 | $394.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.60 / $23.33 / $49.74
| Professional | 26 | $20.60 | $23.33 | $49.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.56 / $204.00 / $358.87
| Professional | TC | $177.56 | $204.00 | $358.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.24 / $279.76 / $423.82
| Professional | | $213.24 | $279.76 | $423.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.47 / $28.55 / $43.85
| Professional | 26 | $22.47 | $28.55 | $43.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.43 / $251.82 / $380.37
| Professional | TC | $190.43 | $251.82 | $380.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Facility | 26 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.62 / $333.20 / $542.28
| Professional | | $242.62 | $333.20 | $542.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.34 / $33.59 / $55.13
| Professional | 26 | $25.34 | $33.59 | $55.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $217.11 / $305.97 / $486.41
| Professional | TC | $217.11 | $305.97 | $486.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.43 / $272.82 / $491.45
| Professional | | $210.43 | $272.82 | $491.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.17 / $27.63 / $54.01
| Professional | 26 | $21.17 | $27.63 | $54.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $189.26 / $244.94 / $447.14
| Professional | TC | $189.26 | $244.94 | $447.14 |