- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $219.42 / $265.29 / $500.75
| Facility | 26 | $219.42 | $265.29 | $500.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.44 / $491.56 / $1,006.54
| Professional | | $427.44 | $491.56 | $1,006.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $188.34 / $239.15 / $612.32
| Professional | 26 | $188.34 | $239.15 | $612.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $220.96 / $270.72 / $466.86
| Professional | TC | $220.96 | $270.72 | $466.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.86 / $572.65 / $949.07
| Professional | | $447.86 | $572.65 | $949.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $218.95 / $270.08 / $442.89
| Professional | 26 | $218.95 | $270.08 | $442.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $228.78 / $310.58 / $495.36
| Professional | TC | $228.78 | $310.58 | $495.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $304.60 / $304.60 / $304.74
| Facility | 26 | $304.60 | $304.60 | $304.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.97 / $677.08 / $1,069.24
| Professional | | $484.97 | $677.08 | $1,069.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $236.76 / $315.12 / $513.17
| Professional | 26 | $236.76 | $315.12 | $513.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $248.21 / $357.98 / $592.44
| Professional | TC | $248.21 | $357.98 | $592.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.42 / $621.64 / $994.62
| Professional | | $464.42 | $621.64 | $994.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $216.15 / $290.52 / $463.99
| Professional | 26 | $216.15 | $290.52 | $463.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $243.70 / $331.11 / $532.11
| Professional | TC | $243.70 | $331.11 | $532.11 |