- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $83.18 / $223.87
| Facility | 26 | $48.98 | $83.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $707.95
| Professional | | $263.03 | $338.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $57.54 / $141.25
| Professional | 26 | $42.66 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $281.84 / $660.69
| Professional | TC | $218.78 | $281.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $870.96
| Professional | | $309.03 | $436.52 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $70.79 / $138.04
| Professional | 26 | $52.48 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $371.54 / $758.58
| Professional | TC | $263.03 | $371.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $77.62 / $239.88
| Facility | 26 | $13.49 | $77.62 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $512.86 / $954.99
| Professional | | $288.40 | $512.86 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $87.10 / $162.18
| Professional | 26 | $48.98 | $87.10 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $436.52 / $794.33
| Professional | TC | $239.88 | $436.52 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $794.33
| Professional | | $302.00 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $66.07 / $128.82
| Professional | 26 | $47.86 | $66.07 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.19 / $338.84 / $660.69
| Professional | TC | $251.19 | $338.84 | $660.69 |