- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $117.49 / $194.98
| Facility | 26 | $83.18 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $346.74 / $776.25
| Professional | | $281.84 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $95.50 / $199.53
| Professional | 26 | $77.62 | $95.50 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $199.53 / $245.47 / $467.74
| Professional | TC | $199.53 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $371.54 / $707.95
| Professional | | $229.09 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $117.49 / $213.80
| Professional | 26 | $79.43 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.36 / $269.15 / $512.86
| Professional | TC | $151.36 | $269.15 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.38 / $123.03 / $346.74
| Facility | 26 | $21.38 | $123.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $977.24
| Professional | | $288.40 | $446.68 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $134.90 / $281.84
| Professional | 26 | $87.10 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.17 / $331.13 / $707.95
| Professional | TC | $204.17 | $331.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $676.08
| Professional | | $251.19 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $109.65 / $194.98
| Professional | 26 | $74.13 | $109.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.78 / $269.15 / $478.63
| Professional | TC | $173.78 | $269.15 | $478.63 |