- 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
- $178.77 / $274.70 / $332.48
| Professional | | $178.77 | $274.70 | $332.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.97 / $53.18 / $83.57
| Professional | 26 | $42.97 | $53.18 | $83.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $124.54 / $215.99 / $270.61
| Professional | TC | $124.54 | $215.99 | $270.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.84 / $245.69 / $522.50
| Professional | | $208.84 | $245.69 | $522.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.76 / $78.23 / $109.34
| Professional | 26 | $54.76 | $78.23 | $109.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $117.22 / $167.46 / $181.73
| Professional | TC | $117.22 | $167.46 | $181.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.08 / $352.76 / $441.02
| Professional | | $182.08 | $352.76 | $441.02 |
- 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
- $126.91 / $244.68 / $317.56
| Professional | TC | $126.91 | $244.68 | $317.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.59 / $250.61 / $379.39
| Professional | | $204.59 | $250.61 | $379.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.22 / $68.09 / $116.72
| Professional | 26 | $52.22 | $68.09 | $116.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $137.50 / $196.41 / $278.50
| Professional | TC | $137.50 | $196.41 | $278.50 |