- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.48 / $93.79 / $167.32
| Facility | 26 | $74.48 | $93.79 | $167.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.85 / $403.68 / $707.44
| Professional | | $342.85 | $403.68 | $707.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.56 / $78.40 / $163.86
| Professional | 26 | $68.56 | $78.40 | $163.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $274.27 / $317.61 / $568.49
| Professional | TC | $274.27 | $317.61 | $568.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.06 / $479.79 / $838.44
| Professional | | $365.06 | $479.79 | $838.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.13 / $93.70 / $158.22
| Professional | 26 | $73.13 | $93.70 | $158.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $291.19 / $401.59 / $684.45
| Professional | TC | $291.19 | $401.59 | $684.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.63 / $83.63 / $83.63
| Facility | 26 | $83.63 | $83.63 | $83.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.61 / $569.98 / $981.40
| Professional | | $432.61 | $569.98 | $981.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.81 / $107.89 / $174.16
| Professional | 26 | $79.81 | $107.89 | $174.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $354.78 / $475.38 / $810.62
| Professional | TC | $354.78 | $475.38 | $810.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.14 / $489.79 / $860.14
| Professional | | $361.14 | $489.79 | $860.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.11 / $89.93 / $153.44
| Professional | 26 | $68.11 | $89.93 | $153.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $291.25 / $389.10 / $713.30
| Professional | TC | $291.25 | $389.10 | $713.30 |