- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.53 / $47.53 / $47.53
| Facility | 26 | $47.53 | $47.53 | $47.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.11 / $372.89 / $469.04
| Professional | | $303.11 | $372.89 | $469.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.36 / $41.46 / $51.50
| Professional | 26 | $35.36 | $41.46 | $51.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $270.92 / $341.64 / $455.15
| Professional | TC | $270.92 | $341.64 | $455.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.72 / $443.62 / $881.84
| Professional | | $216.72 | $443.62 | $881.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.88 / $49.40 / $95.90
| Professional | 26 | $20.88 | $49.40 | $95.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $195.84 / $400.41 / $798.37
| Professional | TC | $195.84 | $400.41 | $798.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.99 / $53.99 / $53.99
| Facility | 26 | $53.99 | $53.99 | $53.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.57 / $389.08 / $764.51
| Professional | | $201.57 | $389.08 | $764.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.41 / $45.27 / $86.28
| Professional | 26 | $23.41 | $45.27 | $86.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.19 / $333.20 / $675.52
| Professional | TC | $177.19 | $333.20 | $675.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.86 / $412.01 / $856.83
| Professional | | $257.86 | $412.01 | $856.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.41 / $49.73 / $93.58
| Professional | 26 | $30.41 | $49.73 | $93.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $226.10 / $371.48 / $719.12
| Professional | TC | $226.10 | $371.48 | $719.12 |