- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.34 / $49.82 / $67.27
| Facility | 26 | $41.34 | $49.82 | $67.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.87 / $392.58 / $412.20
| Professional | | $251.87 | $392.58 | $412.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.17 / $49.83 / $52.32
| Professional | 26 | $33.17 | $49.83 | $52.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.71 / $342.75 / $359.88
| Professional | TC | $218.71 | $342.75 | $359.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.11 / $27.11 / $44.90
| Professional | 26 | $27.11 | $27.11 | $44.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.20 / $356.00 / $391.60
| Professional | | $249.20 | $356.00 | $391.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.31 / $84.73 / $93.20
| Professional | 26 | $59.31 | $84.73 | $93.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $189.89 / $271.27 / $298.39
| Professional | TC | $189.89 | $271.27 | $298.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.97 / $415.85 / $1,806.49
| Professional | | $308.97 | $415.85 | $1,806.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.47 / $55.92 / $206.56
| Professional | 26 | $37.47 | $55.92 | $206.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $264.87 / $362.13 / $1,599.94
| Professional | TC | $264.87 | $362.13 | $1,599.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.68 / $292.02 / $377.93
| Professional | | $201.68 | $292.02 | $377.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.79 / $38.26 / $51.98
| Professional | 26 | $27.79 | $38.26 | $51.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $182.73 / $258.27 / $496.63
| Professional | TC | $182.73 | $258.27 | $496.63 |