- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $123.42 / $159.63 / $870.72
| Facility | 26 | $123.42 | $159.63 | $870.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.97 / $372.49 / $450.30
| Professional | | $275.97 | $372.49 | $450.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.96 / $140.30 / $150.82
| Professional | 26 | $98.96 | $140.30 | $150.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.01 / $227.41 / $299.48
| Professional | TC | $177.01 | $227.41 | $299.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.35 / $330.63 / $552.69
| Professional | | $147.35 | $330.63 | $552.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.89 / $372.01 / $558.67
| Professional | | $300.89 | $372.01 | $558.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $128.31 / $143.41 / $224.52
| Professional | 26 | $128.31 | $143.41 | $224.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $164.46 / $219.27 / $311.58
| Professional | TC | $164.46 | $219.27 | $311.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $357.19 / $697.88 / $697.88
| Facility | 26 | $357.19 | $697.88 | $697.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.57 / $467.54 / $868.52
| Professional | | $342.57 | $467.54 | $868.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $130.30 / $172.58 / $948.42
| Professional | 26 | $130.30 | $172.58 | $948.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $196.01 / $268.11 / $1,923.92
| Professional | TC | $196.01 | $268.11 | $1,923.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.05 / $435.77 / $634.49
| Professional | | $334.05 | $435.77 | $634.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $125.59 / $167.52 / $235.49
| Professional | 26 | $125.59 | $167.52 | $235.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $196.01 / $260.57 / $390.85
| Professional | TC | $196.01 | $260.57 | $390.85 |