- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.12 / $86.12 / $116.26
| Facility | 26 | $86.12 | $86.12 | $116.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.87 / $406.88 / $549.28
| Professional | | $308.87 | $406.88 | $549.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.15 / $86.12 / $116.26
| Professional | 26 | $57.15 | $86.12 | $116.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.71 / $320.76 / $433.02
| Professional | TC | $251.71 | $320.76 | $433.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.52 / $77.63 / $77.63
| Professional | 26 | $61.52 | $77.63 | $77.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.38 / $526.26 / $578.89
| Professional | | $368.38 | $526.26 | $578.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.03 / $117.18 / $128.90
| Professional | 26 | $82.03 | $117.18 | $128.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $286.36 / $409.08 / $449.99
| Professional | TC | $286.36 | $409.08 | $449.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.03 / $463.38 / $1,855.43
| Professional | | $341.03 | $463.38 | $1,855.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.51 / $97.14 / $380.59
| Professional | 26 | $68.51 | $97.14 | $380.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $272.52 / $352.64 / $1,474.87
| Professional | TC | $272.52 | $352.64 | $1,474.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.28 / $313.83 / $545.69
| Professional | | $243.28 | $313.83 | $545.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.06 / $68.56 / $123.17
| Professional | 26 | $50.06 | $68.56 | $123.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $195.28 / $251.07 / $427.67
| Professional | TC | $195.28 | $251.07 | $427.67 |