- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.18 / $65.18 / $65.18
| Facility | 26 | $65.18 | $65.18 | $65.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.70 / $325.58 / $491.64
| Professional | | $294.70 | $325.58 | $491.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.15 / $65.18 / $209.03
| Professional | 26 | $57.15 | $65.18 | $209.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.03 / $260.41 / $393.21
| Professional | TC | $233.03 | $260.41 | $393.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.31 / $453.52 / $666.95
| Professional | | $337.31 | $453.52 | $666.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.02 / $88.64 / $129.44
| Professional | 26 | $66.02 | $88.64 | $129.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $268.74 / $365.49 / $537.49
| Professional | TC | $268.74 | $365.49 | $537.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.17 / $463.22 / $695.97
| Professional | | $279.17 | $463.22 | $695.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.15 / $85.09 / $136.01
| Professional | 26 | $59.15 | $85.09 | $136.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $220.02 / $364.74 / $603.29
| Professional | TC | $220.02 | $364.74 | $603.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.66 / $573.66 / $616.07
| Professional | | $573.66 | $573.66 | $616.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.08 / $489.94 / $613.57
| Professional | | $310.08 | $489.94 | $613.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.07 / $98.07 / $121.04
| Professional | 26 | $62.07 | $98.07 | $121.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $248.01 / $391.86 / $494.32
| Professional | TC | $248.01 | $391.86 | $494.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.19 / $556.05 / $868.85
| Professional | | $326.19 | $556.05 | $868.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.20 / $109.71 / $189.72
| Professional | 26 | $72.20 | $109.71 | $189.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $238.20 / $433.95 / $977.07
| Professional | TC | $238.20 | $433.95 | $977.07 |