- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $74.13 / $194.98
| Facility | 26 | $39.81 | $74.13 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $229.09 / $588.84
| Professional | | $173.78 | $229.09 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $47.86 / $144.54
| Professional | 26 | $34.67 | $47.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.90 / $181.97 / $407.38
| Professional | TC | $134.90 | $181.97 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $549.54
| Professional | | $204.17 | $295.12 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $63.10 / $112.20
| Professional | 26 | $44.67 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $229.09 / $446.68
| Professional | TC | $162.18 | $229.09 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $63.10 / $194.98
| Facility | 26 | $10.96 | $63.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $354.81 / $616.60
| Professional | | $199.53 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $70.79 / $131.83
| Professional | 26 | $40.74 | $70.79 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $154.88 / $275.42 / $501.19
| Professional | TC | $154.88 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $263.03 / $512.86
| Professional | | $199.53 | $263.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $54.95 / $104.71
| Professional | 26 | $39.81 | $54.95 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $154.88 / $208.93 / $407.38
| Professional | TC | $154.88 | $208.93 | $407.38 |