- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.34 / $56.34 / $76.05
| Facility | 26 | $56.34 | $56.34 | $76.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.38 / $278.27 / $331.06
| Professional | | $211.38 | $278.27 | $331.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.10 / $52.82 / $59.15
| Professional | 26 | $41.10 | $52.82 | $59.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.96 / $227.94 / $271.89
| Professional | TC | $169.96 | $227.94 | $271.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.99 / $37.99 / $43.16
| Professional | 26 | $37.99 | $37.99 | $43.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.59 / $256.97 / $303.22
| Professional | | $187.59 | $256.97 | $303.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.99 / $46.56 / $54.94
| Professional | 26 | $33.99 | $46.56 | $54.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $153.60 / $210.41 / $248.28
| Professional | TC | $153.60 | $210.41 | $248.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.29 / $286.73 / $682.59
| Professional | | $205.29 | $286.73 | $682.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.07 / $48.44 / $123.56
| Professional | 26 | $41.07 | $48.44 | $123.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $197.48 / $250.55 / $615.99
| Professional | TC | $197.48 | $250.55 | $615.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.42 / $256.61 / $383.52
| Professional | | $208.42 | $256.61 | $383.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.54 / $46.56 / $64.14
| Professional | 26 | $36.54 | $46.56 | $64.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $171.88 / $214.30 / $326.64
| Professional | TC | $171.88 | $214.30 | $326.64 |