- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $933.25
| Professional | | $346.74 | $501.19 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $141.25 / $323.59
| Professional | 26 | $83.18 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $371.54 / $660.69
| Professional | TC | $257.04 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $75.86 / $117.49
| Professional | 26 | $61.66 | $75.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $489.78 / $575.44
| Professional | | $177.83 | $489.78 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.83 / $190.55 / $245.47
| Professional | 26 | $131.83 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $109.65 / $302.00 / $354.81
| Professional | TC | $109.65 | $302.00 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $954.99
| Professional | | $338.84 | $501.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $131.83 / $234.42
| Professional | 26 | $83.18 | $131.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $269.15 / $389.05 / $794.33
| Professional | TC | $269.15 | $389.05 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $741.31
| Professional | | $295.12 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $87.10 / $131.83
| Professional | 26 | $66.07 | $87.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $309.03 / $616.60
| Professional | TC | $223.87 | $309.03 | $616.60 |