- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.46 / $65.79 / $104.57
| Facility | 26 | $60.46 | $65.79 | $104.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.94 / $171.92 / $296.56
| Professional | | $152.94 | $171.92 | $296.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $60.25 / $94.14
| Professional | 26 | $53.70 | $60.25 | $94.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $97.12 / $112.26 / $197.32
| Professional | TC | $97.12 | $112.26 | $197.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.72 / $302.17 / $419.86
| Professional | | $154.72 | $302.17 | $419.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.76 / $66.47 / $108.54
| Professional | 26 | $53.76 | $66.47 | $108.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $100.01 / $223.96 / $330.03
| Professional | TC | $100.01 | $223.96 | $330.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.70 / $66.70 / $66.70
| Facility | 26 | $66.70 | $66.70 | $66.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.49 / $407.21 / $704.99
| Professional | | $284.49 | $407.21 | $704.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.06 / $78.65 / $131.79
| Professional | 26 | $57.06 | $78.65 | $131.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $221.02 / $333.74 / $565.83
| Professional | TC | $221.02 | $333.74 | $565.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.30 / $369.41 / $663.48
| Professional | | $270.30 | $369.41 | $663.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.68 / $73.56 / $127.14
| Professional | 26 | $54.68 | $73.56 | $127.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $226.01 / $303.43 / $518.53
| Professional | TC | $226.01 | $303.43 | $518.53 |