- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $44.62 / $87.56
| Facility | 26 | $36.31 | $44.62 | $87.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.79 / $411.83 / $778.08
| Professional | | $352.79 | $411.83 | $778.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $39.86 / $87.56
| Professional | 26 | $36.31 | $39.86 | $87.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $314.45 / $375.12 / $690.52
| Professional | TC | $314.45 | $375.12 | $690.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.74 / $96.63 / $96.63
| Professional | 26 | $41.74 | $96.63 | $96.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.00 / $701.00 / $701.00
| Professional | | $701.00 | $701.00 | $701.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.94 / $697.94 / $947.42
| Professional | | $405.94 | $697.94 | $947.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.14 / $68.87 / $101.87
| Professional | 26 | $43.14 | $68.87 | $101.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $362.81 / $629.41 / $856.15
| Professional | TC | $362.81 | $629.41 | $856.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.22 / $473.71 / $986.91
| Professional | | $334.22 | $473.71 | $986.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.52 / $49.04 / $106.56
| Professional | 26 | $34.52 | $49.04 | $106.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $306.45 / $421.74 / $878.63
| Professional | TC | $306.45 | $421.74 | $878.63 |