- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.45 / $45.03 / $51.74
| Facility | 26 | $40.45 | $45.03 | $51.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.52 / $356.21 / $496.60
| Professional | | $300.52 | $356.21 | $496.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.39 / $42.85 / $53.23
| Professional | 26 | $30.39 | $42.85 | $53.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $270.12 / $313.36 / $443.37
| Professional | TC | $270.12 | $313.36 | $443.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.29 / $36.29 / $36.29
| Professional | 26 | $36.29 | $36.29 | $36.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.58 / $364.04 / $598.89
| Professional | | $342.58 | $364.04 | $598.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.87 / $52.23 / $67.12
| Professional | 26 | $43.87 | $52.23 | $67.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $294.37 / $336.75 / $531.76
| Professional | TC | $294.37 | $336.75 | $531.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.52 / $213.68 / $213.68
| Professional | 26 | $31.52 | $213.68 | $213.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.94 / $312.82 / $705.83
| Professional | | $166.94 | $312.82 | $705.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.50 / $35.25 / $76.01
| Professional | 26 | $21.50 | $35.25 | $76.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $145.44 / $262.43 / $620.92
| Professional | TC | $145.44 | $262.43 | $620.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.74 / $353.96 / $532.03
| Professional | | $287.74 | $353.96 | $532.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.36 / $38.31 / $59.84
| Professional | 26 | $30.36 | $38.31 | $59.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $219.62 / $301.35 / $468.04
| Professional | TC | $219.62 | $301.35 | $468.04 |