- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.89 / $58.23 / $98.69
| Facility | 26 | $43.89 | $58.23 | $98.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.86 / $228.16 / $372.39
| Professional | | $188.86 | $228.16 | $372.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.25 / $46.48 / $79.84
| Professional | 26 | $40.25 | $46.48 | $79.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $148.21 / $185.40 / $300.06
| Professional | TC | $148.21 | $185.40 | $300.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.70 / $265.56 / $437.47
| Professional | | $207.70 | $265.56 | $437.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.68 / $58.50 / $92.06
| Professional | 26 | $44.68 | $58.50 | $92.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $160.75 / $212.28 / $344.90
| Professional | TC | $160.75 | $212.28 | $344.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.16 / $52.16 / $52.16
| Facility | 26 | $52.16 | $52.16 | $52.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.54 / $331.78 / $540.92
| Professional | | $241.54 | $331.78 | $540.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.66 / $66.76 / $108.54
| Professional | 26 | $48.66 | $66.76 | $108.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $185.78 / $262.80 / $427.34
| Professional | TC | $185.78 | $262.80 | $427.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.78 / $258.43 / $476.00
| Professional | | $203.78 | $258.43 | $476.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.88 / $54.12 / $97.13
| Professional | 26 | $41.88 | $54.12 | $97.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $159.72 / $211.56 / $370.08
| Professional | TC | $159.72 | $211.56 | $370.08 |