- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $89.13 / $144.54
| Facility | 26 | $85.11 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $426.58 / $707.95
| Professional | | $269.15 | $426.58 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $125.89 / $223.87
| Professional | 26 | $85.11 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $181.97 / $302.00 / $562.34
| Professional | TC | $181.97 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $707.95
| Professional | | $478.63 | $630.96 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $147.91 / $194.98 / $218.78
| Professional | 26 | $147.91 | $194.98 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $331.13 / $436.52 / $489.78
| Professional | TC | $331.13 | $436.52 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $912.01
| Professional | | $338.84 | $524.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $125.89 / $213.80
| Professional | 26 | $77.62 | $125.89 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $371.54 / $660.69
| Professional | TC | $234.42 | $371.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $588.84 / $3,467.37
| Professional | | $316.23 | $588.84 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $165.96 / $660.69
| Professional | 26 | $87.10 | $165.96 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $436.52 / $3,019.95
| Professional | TC | $223.87 | $436.52 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $549.54 / $794.33
| Professional | | $316.23 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $147.91 / $223.87
| Professional | 26 | $77.62 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $407.38 / $660.69
| Professional | TC | $223.87 | $407.38 | $660.69 |