- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.43 / $47.46 / $96.12
| Facility | 26 | $40.43 | $47.46 | $96.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.19 / $436.79 / $718.78
| Professional | | $365.19 | $436.79 | $718.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.71 / $42.89 / $104.91
| Professional | 26 | $36.71 | $42.89 | $104.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $324.95 / $399.06 / $654.91
| Professional | TC | $324.95 | $399.06 | $654.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.57 / $461.89 / $783.26
| Professional | | $354.57 | $461.89 | $783.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.49 / $50.88 / $82.40
| Professional | 26 | $39.49 | $50.88 | $82.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $318.97 / $428.13 / $699.29
| Professional | TC | $318.97 | $428.13 | $699.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.92 / $47.92 / $47.92
| Facility | 26 | $47.92 | $47.92 | $47.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.18 / $629.35 / $1,060.36
| Professional | | $448.18 | $629.35 | $1,060.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.53 / $60.82 / $101.87
| Professional | 26 | $45.53 | $60.82 | $101.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $401.36 / $570.35 / $948.88
| Professional | TC | $401.36 | $570.35 | $948.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.82 / $502.99 / $891.66
| Professional | | $397.82 | $502.99 | $891.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.65 / $50.65 / $89.96
| Professional | 26 | $38.65 | $50.65 | $89.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $349.71 / $443.39 / $826.62
| Professional | TC | $349.71 | $443.39 | $826.62 |