- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.49 / $65.66 / $98.25
| Facility | 26 | $56.49 | $65.66 | $98.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.76 / $370.79 / $663.25
| Professional | | $296.76 | $370.79 | $663.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.32 / $57.91 / $139.58
| Professional | 26 | $51.32 | $57.91 | $139.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.27 / $310.39 / $568.12
| Professional | TC | $251.27 | $310.39 | $568.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.92 / $395.70 / $685.09
| Professional | | $231.92 | $395.70 | $685.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.17 / $66.00 / $103.93
| Professional | 26 | $50.17 | $66.00 | $103.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $181.75 / $340.89 / $574.37
| Professional | TC | $181.75 | $340.89 | $574.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.88 / $63.88 / $63.88
| Facility | 26 | $63.88 | $63.88 | $63.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.77 / $476.21 / $865.42
| Professional | | $260.77 | $476.21 | $865.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.66 / $78.41 / $134.58
| Professional | 26 | $55.66 | $78.41 | $134.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.22 / $403.02 / $736.71
| Professional | TC | $213.22 | $403.02 | $736.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.25 / $419.48 / $813.45
| Professional | | $249.25 | $419.48 | $813.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.07 / $72.81 / $126.11
| Professional | 26 | $53.07 | $72.81 | $126.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $196.27 / $364.72 / $640.04
| Professional | TC | $196.27 | $364.72 | $640.04 |