- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.26 / $74.26 / $90.32
| Facility | 26 | $74.26 | $74.26 | $90.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.13 / $349.32 / $432.05
| Professional | | $237.13 | $349.32 | $432.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.40 / $50.40 / $74.26
| Professional | 26 | $38.40 | $50.40 | $74.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $198.72 / $298.91 / $357.79
| Professional | TC | $198.72 | $298.91 | $357.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.88 / $395.60 / $507.18
| Professional | | $344.88 | $395.60 | $507.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.48 / $69.37 / $88.94
| Professional | 26 | $60.48 | $69.37 | $88.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $284.39 / $326.23 / $418.24
| Professional | TC | $284.39 | $326.23 | $418.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.82 / $461.37 / $621.71
| Professional | | $313.82 | $461.37 | $621.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $79.86 / $109.12
| Professional | 26 | $57.54 | $79.86 | $109.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $258.56 / $390.43 / $512.69
| Professional | TC | $258.56 | $390.43 | $512.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.75 / $380.24 / $595.03
| Professional | | $317.75 | $380.24 | $595.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.12 / $65.44 / $107.33
| Professional | 26 | $52.12 | $65.44 | $107.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.56 / $305.32 / $485.61
| Professional | TC | $263.56 | $305.32 | $485.61 |