- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.38 / $41.10 / $73.50
| Facility | 26 | $33.38 | $41.10 | $73.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.36 / $318.62 / $534.14
| Professional | | $276.36 | $318.62 | $534.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.39 / $35.61 / $79.20
| Professional | 26 | $30.39 | $35.61 | $79.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.62 / $284.99 / $481.78
| Professional | TC | $245.62 | $284.99 | $481.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.97 / $368.28 / $597.91
| Professional | | $288.97 | $368.28 | $597.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.71 / $42.21 / $67.99
| Professional | 26 | $32.71 | $42.21 | $67.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $255.28 / $332.19 / $532.51
| Professional | TC | $255.28 | $332.19 | $532.51 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.78 / $39.78 / $39.78
| Facility | 26 | $39.78 | $39.78 | $39.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.98 / $467.96 / $785.73
| Professional | | $331.98 | $467.96 | $785.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.38 / $50.00 / $82.28
| Professional | 26 | $37.38 | $50.00 | $82.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $293.94 / $415.82 / $706.92
| Professional | TC | $293.94 | $415.82 | $706.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.74 / $369.76 / $673.15
| Professional | | $287.74 | $369.76 | $673.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.59 / $41.41 / $72.48
| Professional | 26 | $31.59 | $41.41 | $72.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.63 / $343.66 / $576.42
| Professional | TC | $257.63 | $343.66 | $576.42 |