- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $148.46 / $178.24 / $342.57
| Facility | 26 | $148.46 | $178.24 | $342.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.47 / $412.71 / $732.91
| Professional | | $317.47 | $412.71 | $732.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.81 / $144.88 / $249.77
| Professional | 26 | $131.81 | $144.88 | $249.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $185.65 / $264.58 / $475.53
| Professional | TC | $185.65 | $264.58 | $475.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.46 / $496.73 / $811.03
| Professional | | $367.46 | $496.73 | $811.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $140.97 / $190.45 / $298.10
| Professional | 26 | $140.97 | $190.45 | $298.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $216.79 / $326.89 / $527.72
| Professional | TC | $216.79 | $326.89 | $527.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $205.21 / $205.21 / $205.58
| Facility | 26 | $205.21 | $205.21 | $205.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.73 / $538.19 / $988.86
| Professional | | $372.73 | $538.19 | $988.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $159.31 / $212.68 / $344.53
| Professional | 26 | $159.31 | $212.68 | $344.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.57 / $317.14 / $623.79
| Professional | TC | $223.57 | $317.14 | $623.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.19 / $489.00 / $789.13
| Professional | | $352.19 | $489.00 | $789.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $145.72 / $196.24 / $315.58
| Professional | 26 | $145.72 | $196.24 | $315.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $210.80 / $301.08 / $495.08
| Professional | TC | $210.80 | $301.08 | $495.08 |