- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $271.17 / $271.17 / $271.17
| Facility | 26 | $271.17 | $271.17 | $271.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.45 / $411.83 / $443.97
| Professional | | $386.45 | $411.83 | $443.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.71 / $39.83 / $48.03
| Professional | 26 | $36.71 | $39.83 | $48.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $346.61 / $375.12 / $403.07
| Professional | TC | $346.61 | $375.12 | $403.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.82 / $469.82 / $839.45
| Professional | | $469.82 | $469.82 | $839.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.74 / $49.63 / $80.79
| Professional | 26 | $34.74 | $49.63 | $80.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $294.13 / $420.19 / $420.19
| Professional | TC | $294.13 | $420.19 | $420.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.40 / $916.30 / $1,068.81
| Professional | | $489.40 | $916.30 | $1,068.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.70 / $85.42 / $90.74
| Professional | 26 | $51.70 | $85.42 | $90.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $437.70 / $830.12 / $980.77
| Professional | TC | $437.70 | $830.12 | $980.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.03 / $515.40 / $765.78
| Professional | | $335.03 | $515.40 | $765.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.01 / $50.65 / $75.45
| Professional | 26 | $33.01 | $50.65 | $75.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $302.02 / $411.43 / $690.32
| Professional | TC | $302.02 | $411.43 | $690.32 |