- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $66.07 / $169.82
| Facility | 26 | $41.69 | $66.07 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $331.13 / $794.33
| Professional | | $257.04 | $331.13 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $57.54 / $169.82
| Professional | 26 | $40.74 | $57.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.80 / $281.84 / $645.65
| Professional | TC | $213.80 | $281.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $741.31
| Professional | | $245.47 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $64.57 / $117.49
| Professional | 26 | $45.71 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.98 / $302.00 / $630.96
| Professional | TC | $194.98 | $302.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $66.07 / $204.17
| Facility | 26 | $11.48 | $66.07 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $933.25
| Professional | | $275.42 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $74.13 / $138.04
| Professional | 26 | $41.69 | $74.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $416.87 / $794.33
| Professional | TC | $223.87 | $416.87 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $371.54 / $758.58
| Professional | | $257.04 | $371.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $56.23 / $109.65
| Professional | 26 | $41.69 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $316.23 / $645.65
| Professional | TC | $218.78 | $316.23 | $645.65 |