- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $56.95 / $59.86
| Facility | 26 | $42.66 | $56.95 | $59.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.03 / $239.93 / $357.15
| Professional | | $182.03 | $239.93 | $357.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.83 / $39.47 / $81.39
| Professional | 26 | $31.83 | $39.47 | $81.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $145.11 / $200.24 / $417.82
| Professional | TC | $145.11 | $200.24 | $417.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.54 / $237.17 / $556.57
| Professional | | $140.54 | $237.17 | $556.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.43 / $42.52 / $82.11
| Professional | 26 | $18.43 | $42.52 | $82.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $122.11 / $202.82 / $483.69
| Professional | TC | $122.11 | $202.82 | $483.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.33 / $47.33 / $47.33
| Facility | 26 | $47.33 | $47.33 | $47.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.19 / $224.37 / $485.75
| Professional | | $114.19 | $224.37 | $485.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.80 / $41.00 / $77.09
| Professional | 26 | $21.80 | $41.00 | $77.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $90.10 / $184.88 / $412.05
| Professional | TC | $90.10 | $184.88 | $412.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.36 / $280.08 / $551.42
| Professional | | $172.36 | $280.08 | $551.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.09 / $44.85 / $84.02
| Professional | 26 | $27.09 | $44.85 | $84.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.13 / $239.75 / $483.31
| Professional | TC | $138.13 | $239.75 | $483.31 |