- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $220.09 / $283.27 / $500.75
| Facility | 26 | $220.09 | $283.27 | $500.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.96 / $557.72 / $1,401.66
| Professional | | $438.96 | $557.72 | $1,401.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $198.28 / $243.25 / $603.90
| Professional | 26 | $198.28 | $243.25 | $603.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.30 / $337.33 / $608.05
| Professional | TC | $233.30 | $337.33 | $608.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.92 / $670.26 / $1,327.84
| Professional | | $461.92 | $670.26 | $1,327.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $219.08 / $287.33 / $454.50
| Professional | 26 | $219.08 | $287.33 | $454.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $240.04 / $388.08 / $811.73
| Professional | TC | $240.04 | $388.08 | $811.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $256.04 / $256.04 / $256.04
| Facility | 26 | $256.04 | $256.04 | $256.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.54 / $810.87 / $1,478.92
| Professional | | $515.54 | $810.87 | $1,478.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $217.81 / $325.83 / $516.16
| Professional | 26 | $217.81 | $325.83 | $516.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $264.48 / $438.35 / $936.28
| Professional | TC | $264.48 | $438.35 | $936.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $697.26 / $1,334.44
| Professional | | $484.14 | $697.26 | $1,334.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $215.04 / $285.83 / $469.29
| Professional | 26 | $215.04 | $285.83 | $469.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.64 / $389.68 / $873.02
| Professional | TC | $257.64 | $389.68 | $873.02 |