- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.49 / $48.25 / $82.75
| Facility | 26 | $38.49 | $48.25 | $82.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.62 / $267.87 / $499.63
| Professional | | $229.62 | $267.87 | $499.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.75 / $42.86 / $106.76
| Professional | 26 | $36.75 | $42.86 | $106.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $192.87 / $225.33 / $422.53
| Professional | TC | $192.87 | $225.33 | $422.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.18 / $311.77 / $496.51
| Professional | | $256.18 | $311.77 | $496.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.53 / $51.39 / $79.46
| Professional | 26 | $39.53 | $51.39 | $79.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.15 / $265.09 / $414.15
| Professional | TC | $213.15 | $265.09 | $414.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.62 / $45.62 / $45.62
| Facility | 26 | $45.62 | $45.62 | $45.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.24 / $361.36 / $627.66
| Professional | | $230.24 | $361.36 | $627.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.66 / $58.49 / $94.64
| Professional | 26 | $41.66 | $58.49 | $94.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $184.78 / $303.70 / $539.97
| Professional | TC | $184.78 | $303.70 | $539.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.27 / $313.72 / $591.07
| Professional | | $216.27 | $313.72 | $591.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.83 / $48.35 / $87.02
| Professional | 26 | $36.83 | $48.35 | $87.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $182.82 / $275.61 / $505.58
| Professional | TC | $182.82 | $275.61 | $505.58 |