- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $224.66 / $243.43 / $261.69
| Facility | 26 | $224.66 | $243.43 | $261.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.47 / $581.87 / $732.72
| Professional | | $317.47 | $581.87 | $732.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.81 / $224.66 / $267.77
| Professional | 26 | $131.81 | $224.66 | $267.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $185.65 / $357.21 / $475.53
| Professional | TC | $185.65 | $357.21 | $475.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.04 / $589.54 / $723.87
| Professional | | $524.04 | $589.54 | $723.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $177.41 / $230.73 / $270.81
| Professional | 26 | $177.41 | $230.73 | $270.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $309.26 / $367.01 / $472.71
| Professional | TC | $309.26 | $367.01 | $472.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $139.77 / $139.77
| Professional | 26 | $40.00 | $139.77 | $139.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.23 / $436.71 / $668.96
| Professional | | $298.23 | $436.71 | $668.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.36 / $156.87 / $296.58
| Professional | 26 | $104.36 | $156.87 | $296.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $193.87 / $282.14 / $406.33
| Professional | TC | $193.87 | $282.14 | $406.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.33 / $417.56 / $659.29
| Professional | | $265.33 | $417.56 | $659.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.95 / $159.05 / $264.16
| Professional | 26 | $117.95 | $159.05 | $264.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $150.34 / $255.56 / $375.62
| Professional | TC | $150.34 | $255.56 | $375.62 |