- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $382.32 / $382.32 / $531.91
| Facility | 26 | $382.32 | $382.32 | $531.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.90 / $252.85 / $413.97
| Professional | | $214.90 | $252.85 | $413.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.09 / $57.89 / $67.27
| Professional | 26 | $47.09 | $57.89 | $67.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $153.24 / $175.12 / $346.70
| Professional | TC | $153.24 | $175.12 | $346.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.81 / $290.36 / $629.55
| Professional | | $246.81 | $290.36 | $629.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.77 / $85.38 / $118.48
| Professional | 26 | $59.77 | $85.38 | $118.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $143.49 / $204.99 / $222.28
| Professional | TC | $143.49 | $204.99 | $222.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.63 / $425.00 / $562.61
| Professional | | $216.63 | $425.00 | $562.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.46 / $121.06 / $127.93
| Professional | 26 | $55.46 | $121.06 | $127.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $156.76 / $297.88 / $423.18
| Professional | TC | $156.76 | $297.88 | $423.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.86 / $333.18 / $472.47
| Professional | | $197.86 | $333.18 | $472.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.95 / $74.92 / $127.34
| Professional | 26 | $56.95 | $74.92 | $127.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $142.94 / $247.28 / $343.06
| Professional | TC | $142.94 | $247.28 | $343.06 |