- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $229.63 / $229.63 / $391.72
| Facility | 26 | $229.63 | $229.63 | $391.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.91 / $504.95 / $1,051.97
| Professional | | $472.91 | $504.95 | $1,051.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $198.28 / $229.63 / $1,022.40
| Professional | 26 | $198.28 | $229.63 | $1,022.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $244.94 / $306.66 / $381.89
| Professional | TC | $244.94 | $306.66 | $381.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.67 / $1,011.70 / $1,195.33
| Professional | | $938.67 | $1,011.70 | $1,195.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $438.13 / $470.07 / $555.39
| Professional | 26 | $438.13 | $470.07 | $555.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $500.54 / $541.63 / $639.94
| Professional | TC | $500.54 | $541.63 | $639.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.76 / $930.63 / $1,445.01
| Professional | | $652.76 | $930.63 | $1,445.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $266.95 / $428.20 / $535.60
| Professional | 26 | $266.95 | $428.20 | $535.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $361.52 / $502.43 / $1,025.25
| Professional | TC | $361.52 | $502.43 | $1,025.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.41 / $988.26 / $7,381.05
| Professional | | $545.41 | $988.26 | $7,381.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $232.42 / $445.62 / $1,699.00
| Professional | 26 | $232.42 | $445.62 | $1,699.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $300.32 / $546.04 / $6,233.93
| Professional | TC | $300.32 | $546.04 | $6,233.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.04 / $931.04 / $1,240.99
| Professional | | $498.04 | $931.04 | $1,240.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $232.42 / $401.06 / $573.58
| Professional | 26 | $232.42 | $401.06 | $573.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $265.62 / $491.43 / $667.41
| Professional | TC | $265.62 | $491.43 | $667.41 |