- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $350.35 / $350.35 / $487.44
| Facility | 26 | $350.35 | $350.35 | $487.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.15 / $272.22 / $329.48
| Professional | | $176.15 | $272.22 | $329.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.97 / $53.18 / $62.85
| Professional | 26 | $42.97 | $53.18 | $62.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $133.18 / $222.12 / $272.63
| Professional | TC | $133.18 | $222.12 | $272.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.67 / $294.89 / $514.45
| Professional | | $250.67 | $294.89 | $514.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.76 / $78.23 / $108.67
| Professional | 26 | $54.76 | $78.23 | $108.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.66 / $216.67 / $220.37
| Professional | TC | $151.66 | $216.67 | $220.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.60 / $425.39 / $464.72
| Professional | | $202.60 | $425.39 | $464.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.58 / $105.00 / $117.24
| Professional | 26 | $50.58 | $105.00 | $117.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $146.78 / $314.48 / $352.61
| Professional | TC | $146.78 | $314.48 | $352.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.47 / $292.00 / $410.63
| Professional | | $222.47 | $292.00 | $410.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.65 / $66.54 / $106.06
| Professional | 26 | $42.65 | $66.54 | $106.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $166.15 / $221.34 / $332.38
| Professional | TC | $166.15 | $221.34 | $332.38 |