- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $199.53 / $416.87
| Facility | 26 | $181.97 | $199.53 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $831.76
| Professional | | $346.74 | $478.63 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $123.03 / $208.93
| Professional | 26 | $85.11 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $338.84 / $630.96
| Professional | TC | $257.04 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $562.34 / $933.25
| Professional | | $281.84 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $117.49 / $239.88
| Professional | 26 | $72.44 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $436.52 / $758.58
| Professional | TC | $234.42 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $616.60 / $616.60 / $794.33
| Facility | 26 | $616.60 | $616.60 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $3,019.95
| Professional | | $380.19 | $588.84 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $112.20 / $851.14
| Professional | 26 | $83.18 | $112.20 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $467.74 / $2,570.40
| Professional | TC | $288.40 | $467.74 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $707.95
| Professional | | $380.19 | $512.86 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $97.72 / $154.88
| Professional | 26 | $83.18 | $97.72 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $398.11 / $562.34
| Professional | TC | $288.40 | $398.11 | $562.34 |