- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.46 / $66.64 / $66.64
| Facility | 26 | $45.46 | $66.64 | $66.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.13 / $396.12 / $396.12
| Professional | | $271.13 | $396.12 | $396.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.47 / $66.64 / $66.64
| Professional | 26 | $43.47 | $66.64 | $66.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $224.13 / $329.48 / $329.48
| Professional | TC | $224.13 | $329.48 | $329.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.38 / $60.25 / $60.25
| Professional | 26 | $36.38 | $60.25 | $60.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.75 / $316.79 / $348.47
| Professional | | $221.75 | $316.79 | $348.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.22 / $51.76 / $56.94
| Professional | 26 | $36.22 | $51.76 | $56.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $185.52 / $265.02 / $291.52
| Professional | TC | $185.52 | $265.02 | $291.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.46 / $473.98 / $1,816.83
| Professional | | $334.46 | $473.98 | $1,816.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.79 / $75.94 / $297.83
| Professional | 26 | $53.79 | $75.94 | $297.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $280.66 / $398.03 / $1,519.01
| Professional | TC | $280.66 | $398.03 | $1,519.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.00 / $309.70 / $448.12
| Professional | | $241.00 | $309.70 | $448.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.43 / $51.76 / $72.45
| Professional | 26 | $38.43 | $51.76 | $72.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $203.36 / $257.95 / $377.50
| Professional | TC | $203.36 | $257.95 | $377.50 |