- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $53.70 / $144.54
| Facility | 26 | $34.67 | $53.70 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $562.34
| Professional | | $181.97 | $223.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $45.71 / $109.65
| Professional | 26 | $26.30 | $45.71 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $144.54 / $177.83 / $354.81
| Professional | TC | $144.54 | $177.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | 26 | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $223.87 / $407.38
| Professional | | $154.88 | $223.87 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $37.15 / $67.61
| Professional | 26 | $23.44 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $131.83 / $190.55 / $346.74
| Professional | TC | $131.83 | $190.55 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $48.98 / $117.49
| Facility | 26 | $9.12 | $48.98 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $562.34
| Professional | | $190.55 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $44.67 / $102.33
| Professional | 26 | $26.30 | $44.67 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $154.88 / $251.19 / $478.63
| Professional | TC | $154.88 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $251.19 / $446.68
| Professional | | $177.83 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $40.74 / $79.43
| Professional | 26 | $23.99 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $144.54 / $213.80 / $380.19
| Professional | TC | $144.54 | $213.80 | $380.19 |