- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $367.37 / $367.37 / $511.12
| Facility | 26 | $367.37 | $367.37 | $511.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.96 / $350.87 / $424.19
| Professional | | $213.96 | $350.87 | $424.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.63 / $56.04 / $65.12
| Professional | 26 | $44.63 | $56.04 | $65.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $153.24 / $266.42 / $359.07
| Professional | TC | $153.24 | $266.42 | $359.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.83 / $288.04 / $653.15
| Professional | | $244.83 | $288.04 | $653.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.11 / $81.59 / $113.90
| Professional | 26 | $57.11 | $81.59 | $113.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $144.51 / $206.45 / $230.87
| Professional | TC | $144.51 | $206.45 | $230.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.53 / $422.44 / $571.63
| Professional | | $213.53 | $422.44 | $571.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.45 / $115.70 / $122.92
| Professional | 26 | $52.45 | $115.70 | $122.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $161.38 / $301.14 / $423.18
| Professional | TC | $161.38 | $301.14 | $423.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.76 / $329.71 / $464.74
| Professional | | $246.76 | $329.71 | $464.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.76 / $77.09 / $162.19
| Professional | 26 | $54.76 | $77.09 | $162.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $174.68 / $248.44 / $343.06
| Professional | TC | $174.68 | $248.44 | $343.06 |