- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $70.79 / $181.97
| Facility | 26 | $42.66 | $70.79 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $758.58
| Professional | | $251.19 | $316.23 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $58.88 / $177.83
| Professional | 26 | $41.69 | $58.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.93 / $269.15 / $537.03
| Professional | TC | $208.93 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $776.25
| Professional | | $281.84 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.77 / $61.66 / $117.49
| Professional | 26 | $46.77 | $61.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.88 / $331.13 / $660.69
| Professional | TC | $239.88 | $331.13 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $69.18 / $213.80
| Facility | 26 | $12.02 | $69.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $489.78 / $891.25
| Professional | | $269.15 | $489.78 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $77.62 / $144.54
| Professional | 26 | $43.65 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.09 / $407.38 / $758.58
| Professional | TC | $229.09 | $407.38 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $741.31
| Professional | | $275.42 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $58.88 / $114.82
| Professional | 26 | $42.66 | $58.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.09 / $316.23 / $630.96
| Professional | TC | $229.09 | $316.23 | $630.96 |