- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $369.55 / $369.55 / $514.16
| Facility | 26 | $369.55 | $369.55 | $514.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.46 / $282.68 / $342.10
| Professional | | $181.46 | $282.68 | $342.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.08 / $58.61 / $87.94
| Professional | 26 | $45.08 | $58.61 | $87.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $124.89 / $217.25 / $276.99
| Professional | TC | $124.89 | $217.25 | $276.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.28 / $250.92 / $528.41
| Professional | | $213.28 | $250.92 | $528.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.74 / $82.48 / $114.57
| Professional | 26 | $57.74 | $82.48 | $114.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $117.90 / $168.43 / $181.73
| Professional | TC | $117.90 | $168.43 | $181.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.54 / $381.06 / $502.58
| Professional | | $185.54 | $381.06 | $502.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.04 / $116.95 / $123.65
| Professional | 26 | $53.04 | $116.95 | $123.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $127.45 / $245.37 / $351.68
| Professional | TC | $127.45 | $245.37 | $351.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.84 / $291.98 / $479.42
| Professional | | $207.84 | $291.98 | $479.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.76 / $72.04 / $111.87
| Professional | 26 | $54.76 | $72.04 | $111.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $137.00 / $202.16 / $317.95
| Professional | TC | $137.00 | $202.16 | $317.95 |