- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $241.06 / $241.06 / $241.06
| Facility | 26 | $241.06 | $241.06 | $241.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.26 / $520.46 / $1,248.39
| Professional | | $444.26 | $520.46 | $1,248.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $214.80 / $382.44 / $975.33
| Professional | 26 | $214.80 | $382.44 | $975.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $232.34 / $279.39 / $1,485.95
| Professional | TC | $232.34 | $279.39 | $1,485.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.91 / $654.62 / $860.73
| Professional | | $549.91 | $654.62 | $860.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $268.50 / $307.80 / $420.41
| Professional | 26 | $268.50 | $307.80 | $420.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $281.41 / $332.72 / $440.32
| Professional | TC | $281.41 | $332.72 | $440.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.19 / $213.97 / $452.85
| Professional | | $154.19 | $213.97 | $452.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $616.40 / $616.40 / $616.40
| Facility | 26 | $616.40 | $616.40 | $616.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.98 / $914.85 / $1,025.11
| Professional | | $696.98 | $914.85 | $1,025.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $332.63 / $421.66 / $466.73
| Professional | 26 | $332.63 | $421.66 | $466.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $364.36 / $493.15 / $558.40
| Professional | TC | $364.36 | $493.15 | $558.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.31 / $621.64 / $826.79
| Professional | | $497.31 | $621.64 | $826.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $232.42 / $290.52 / $383.49
| Professional | 26 | $232.42 | $290.52 | $383.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $264.89 / $331.11 / $463.50
| Professional | TC | $264.89 | $331.11 | $463.50 |