- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $60.26 / $123.03
| Facility | 26 | $60.26 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $616.60
| Professional | | $302.00 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $75.86 / $208.93
| Professional | 26 | $60.26 | $75.86 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $323.59 / $512.86
| Professional | TC | $239.88 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $54.95 / $56.23
| Professional | 26 | $54.95 | $54.95 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $562.34
| Professional | | $446.68 | $501.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $109.65 / $123.03
| Professional | 26 | $85.11 | $109.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $363.08 / $389.05 / $436.52
| Professional | TC | $363.08 | $389.05 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $70.79 / $70.79
| Professional | 26 | $39.81 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $380.19 / $707.95
| Professional | | $190.55 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $81.28 / $162.18
| Professional | 26 | $45.71 | $81.28 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.83 / $331.13 / $575.44
| Professional | TC | $177.83 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $630.96
| Professional | | $323.59 | $436.52 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $79.43 / $114.82
| Professional | 26 | $63.10 | $79.43 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $346.74 / $467.74
| Professional | TC | $257.04 | $346.74 | $467.74 |