- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $529.69 / $529.69 / $736.96
| Facility | 26 | $529.69 | $529.69 | $736.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.98 / $431.45 / $467.02
| Professional | | $232.98 | $431.45 | $467.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.01 / $88.48 / $188.12
| Professional | 26 | $65.01 | $88.48 | $188.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $167.97 / $346.05 / $373.69
| Professional | TC | $167.97 | $346.05 | $373.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.83 / $386.27 / $1,006.29
| Professional | | $311.83 | $386.27 | $1,006.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.61 / $118.02 / $163.93
| Professional | 26 | $82.61 | $118.02 | $163.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $187.78 / $268.25 / $268.25
| Professional | TC | $187.78 | $268.25 | $268.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.26 / $584.12 / $690.61
| Professional | | $282.26 | $584.12 | $690.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.59 / $159.06 / $177.23
| Professional | 26 | $76.59 | $159.06 | $177.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $196.58 / $417.42 / $503.87
| Professional | TC | $196.58 | $417.42 | $503.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.30 / $435.05 / $656.10
| Professional | | $314.30 | $435.05 | $656.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.08 / $103.01 / $175.36
| Professional | 26 | $76.08 | $103.01 | $175.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $180.07 / $311.41 / $512.35
| Professional | TC | $180.07 | $311.41 | $512.35 |