- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.88 / $41.42 / $68.04
| Facility | 26 | $38.88 | $41.42 | $68.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $283.68 / $446.26
| Professional | | $234.42 | $283.68 | $446.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.21 / $40.22 / $56.38
| Professional | 26 | $35.21 | $40.22 | $56.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $198.43 / $236.99 / $361.09
| Professional | TC | $198.43 | $236.99 | $361.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.91 / $270.85 / $472.44
| Professional | | $231.91 | $270.85 | $472.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.44 / $41.47 / $71.44
| Professional | 26 | $35.44 | $41.47 | $71.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.45 / $232.62 / $396.84
| Professional | TC | $194.45 | $232.62 | $396.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.98 / $42.98 / $42.98
| Facility | 26 | $42.98 | $42.98 | $42.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.42 / $350.16 / $571.66
| Professional | | $243.42 | $350.16 | $571.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.11 / $52.34 / $83.60
| Professional | 26 | $37.11 | $52.34 | $83.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $206.34 / $296.24 / $485.92
| Professional | TC | $206.34 | $296.24 | $485.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.72 / $331.31 / $532.65
| Professional | | $241.72 | $331.31 | $532.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.38 / $49.17 / $79.06
| Professional | 26 | $36.38 | $49.17 | $79.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.85 / $281.95 / $459.32
| Professional | TC | $208.85 | $281.95 | $459.32 |