- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.39 / $147.19 / $164.19
| Facility | 26 | $127.39 | $147.19 | $164.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.49 / $520.12 / $575.97
| Professional | | $326.49 | $520.12 | $575.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.87 / $161.16 / $183.73
| Professional | 26 | $105.87 | $161.16 | $183.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.43 / $355.93 / $410.83
| Professional | TC | $229.43 | $355.93 | $410.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.68 / $486.61 / $572.48
| Professional | | $425.68 | $486.61 | $572.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $136.19 / $145.60 / $190.62
| Professional | 26 | $136.19 | $145.60 | $190.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $284.18 / $334.33 / $401.19
| Professional | TC | $284.18 | $334.33 | $401.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $139.30 / $139.30 / $139.30
| Professional | 26 | $139.30 | $139.30 | $139.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.97 / $447.46 / $556.08
| Professional | | $357.97 | $447.46 | $556.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.06 / $137.82 / $184.44
| Professional | 26 | $110.06 | $137.82 | $184.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $242.88 / $309.67 / $419.87
| Professional | TC | $242.88 | $309.67 | $419.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.08 / $423.55 / $677.19
| Professional | | $285.08 | $423.55 | $677.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.66 / $144.44 / $279.43
| Professional | 26 | $93.66 | $144.44 | $279.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.44 / $285.27 / $456.12
| Professional | TC | $188.44 | $285.27 | $456.12 |