- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.59 / $70.40 / $127.02
| Facility | 26 | $53.59 | $70.40 | $127.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.30 / $334.04 / $484.86
| Professional | | $295.30 | $334.04 | $484.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.97 / $53.78 / $99.24
| Professional | 26 | $48.97 | $53.78 | $99.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $242.52 / $280.99 / $450.64
| Professional | TC | $242.52 | $280.99 | $450.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.91 / $414.16 / $669.66
| Professional | | $319.91 | $414.16 | $669.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.20 / $69.61 / $113.40
| Professional | 26 | $54.20 | $69.61 | $113.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $265.70 / $357.74 / $559.89
| Professional | TC | $265.70 | $357.74 | $559.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.78 / $63.78 / $63.78
| Facility | 26 | $63.78 | $63.78 | $63.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.91 / $490.02 / $791.35
| Professional | | $361.91 | $490.02 | $791.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.35 / $80.12 / $132.69
| Professional | 26 | $60.35 | $80.12 | $132.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $300.24 / $418.54 / $667.64
| Professional | TC | $300.24 | $418.54 | $667.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.99 / $413.73 / $741.48
| Professional | | $312.99 | $413.73 | $741.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.89 / $66.23 / $119.76
| Professional | 26 | $50.89 | $66.23 | $119.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.56 / $344.49 / $595.37
| Professional | TC | $263.56 | $344.49 | $595.37 |