- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.52 / $109.88 / $179.77
| Facility | 26 | $100.52 | $109.88 | $179.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.74 / $340.22 / $590.40
| Professional | | $293.74 | $340.22 | $590.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.57 / $102.65 / $178.57
| Professional | 26 | $89.57 | $102.65 | $178.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.15 / $240.27 / $426.90
| Professional | TC | $204.15 | $240.27 | $426.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.01 / $444.75 / $650.12
| Professional | | $317.01 | $444.75 | $650.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.28 / $129.16 / $199.79
| Professional | 26 | $98.28 | $129.16 | $199.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $221.92 / $300.30 / $450.87
| Professional | TC | $221.92 | $300.30 | $450.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $138.30 / $138.30 / $138.30
| Facility | 26 | $138.30 | $138.30 | $138.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.29 / $459.67 / $750.65
| Professional | | $329.29 | $459.67 | $750.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.79 / $143.00 / $233.44
| Professional | 26 | $107.79 | $143.00 | $233.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $222.49 / $313.02 / $528.48
| Professional | TC | $222.49 | $313.02 | $528.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.68 / $417.59 / $667.13
| Professional | | $312.68 | $417.59 | $667.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.32 / $132.03 / $214.85
| Professional | 26 | $99.32 | $132.03 | $214.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $209.01 / $294.16 / $473.14
| Professional | TC | $209.01 | $294.16 | $473.14 |