- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $70.79 / $190.55
| Facility | 26 | $43.65 | $70.79 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $524.81
| Professional | | $208.93 | $275.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $53.70 / $144.54
| Professional | 26 | $41.69 | $53.70 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $229.09 / $436.52
| Professional | TC | $162.18 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | 26 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $524.81
| Professional | | $186.21 | $275.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $56.23 / $97.72
| Professional | 26 | $38.02 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $147.91 / $223.87 / $436.52
| Professional | TC | $147.91 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $58.88 / $141.25
| Facility | 26 | $10.96 | $58.88 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $758.58
| Professional | | $251.19 | $389.05 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $64.57 / $125.89
| Professional | 26 | $44.67 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.93 / $323.59 / $645.65
| Professional | TC | $208.93 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $588.84
| Professional | | $234.42 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $54.95 / $97.72
| Professional | 26 | $40.74 | $54.95 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.98 / $275.42 / $501.19
| Professional | TC | $194.98 | $275.42 | $501.19 |