- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.57 / $56.63 / $59.46
| Facility | 26 | $38.57 | $56.63 | $59.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.34 / $518.88 / $518.89
| Professional | | $354.34 | $518.88 | $518.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.71 / $56.63 / $56.63
| Professional | 26 | $36.71 | $56.63 | $56.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $314.45 / $462.25 / $462.26
| Professional | TC | $314.45 | $462.25 | $462.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.86 / $30.86 / $30.86
| Professional | 26 | $30.86 | $30.86 | $30.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.64 / $423.77 / $466.15
| Professional | | $296.64 | $423.77 | $466.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.41 / $59.16 / $65.08
| Professional | 26 | $41.41 | $59.16 | $65.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $255.23 / $364.61 / $401.07
| Professional | TC | $255.23 | $364.61 | $401.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.67 / $634.64 / $2,429.04
| Professional | | $447.67 | $634.64 | $2,429.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.53 / $64.29 / $252.07
| Professional | 26 | $45.53 | $64.29 | $252.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $402.15 / $570.35 / $2,176.98
| Professional | TC | $402.15 | $570.35 | $2,176.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.08 / $409.38 / $625.76
| Professional | | $320.08 | $409.38 | $625.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.40 / $44.02 / $61.63
| Professional | 26 | $32.40 | $44.02 | $61.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.00 / $365.36 / $565.54
| Professional | TC | $288.00 | $365.36 | $565.54 |