- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.80 / $380.19 / $380.19
| Facility | 26 | $213.80 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $1,148.15
| Professional | | $346.74 | $524.81 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $186.21 / $354.81 / $660.69
| Professional | 26 | $186.21 | $354.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.78 / $263.03 / $549.54
| Professional | TC | $173.78 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $371.54 / $537.03
| Professional | | $354.81 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $204.17 / $316.23
| Professional | 26 | $181.97 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $707.95
| Professional | | $416.87 | $602.56 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $190.55 / $269.15 / $323.59
| Professional | 26 | $190.55 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.09 / $331.13 / $389.05
| Professional | TC | $229.09 | $331.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $1,023.29
| Professional | | $426.58 | $575.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $223.87 / $275.42 / $467.74
| Professional | 26 | $223.87 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.09 / $316.23 / $549.54
| Professional | TC | $229.09 | $316.23 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $645.65
| Professional | | $363.08 | $501.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $169.82 / $234.42 / $309.03
| Professional | 26 | $169.82 | $234.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $263.03 / $331.13
| Professional | TC | $190.55 | $263.03 | $331.13 |