- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.07 / $55.67 / $70.54
| Facility | 26 | $50.07 | $55.67 | $70.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.83 / $480.66 / $667.57
| Professional | | $411.83 | $480.66 | $667.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.71 / $52.97 / $64.80
| Professional | 26 | $36.71 | $52.97 | $64.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $375.12 / $427.69 / $602.77
| Professional | TC | $375.12 | $427.69 | $602.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.98 / $43.98 / $78.95
| Professional | 26 | $43.98 | $43.98 | $78.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.24 / $486.83 / $743.42
| Professional | | $458.24 | $486.83 | $743.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.57 / $62.89 / $81.23
| Professional | 26 | $53.57 | $62.89 | $81.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $400.25 / $457.86 / $663.36
| Professional | TC | $400.25 | $457.86 | $663.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.22 / $168.23 / $168.23
| Professional | 26 | $38.22 | $168.23 | $168.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.86 / $420.42 / $952.45
| Professional | | $223.86 | $420.42 | $952.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.08 / $42.66 / $91.66
| Professional | 26 | $26.08 | $42.66 | $91.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $197.79 / $357.06 / $847.48
| Professional | TC | $197.79 | $357.06 | $847.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.82 / $468.57 / $876.79
| Professional | | $397.82 | $468.57 | $876.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.56 / $46.37 / $72.06
| Professional | 26 | $36.56 | $46.37 | $72.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $349.71 / $411.43 / $719.40
| Professional | TC | $349.71 | $411.43 | $719.40 |