- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.88 / $93.25 / $175.95
| Facility | 26 | $71.88 | $93.25 | $175.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.03 / $486.08 / $1,067.05
| Professional | | $400.03 | $486.08 | $1,067.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.62 / $78.38 / $197.89
| Professional | 26 | $67.62 | $78.38 | $197.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $326.62 / $414.12 / $692.26
| Professional | TC | $326.62 | $414.12 | $692.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.01 / $525.26 / $815.16
| Professional | | $411.01 | $525.26 | $815.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.23 / $91.99 / $149.58
| Professional | 26 | $73.23 | $91.99 | $149.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $336.73 / $449.71 / $677.23
| Professional | TC | $336.73 | $449.71 | $677.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.17 / $86.17 / $86.17
| Facility | 26 | $86.17 | $86.17 | $86.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.84 / $647.03 / $1,060.48
| Professional | | $431.84 | $647.03 | $1,060.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.34 / $108.69 / $178.79
| Professional | 26 | $80.34 | $108.69 | $178.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $360.34 / $547.32 / $893.77
| Professional | TC | $360.34 | $547.32 | $893.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.08 / $606.98 / $1,015.64
| Professional | | $419.08 | $606.98 | $1,015.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.54 / $106.15 / $179.42
| Professional | 26 | $71.54 | $106.15 | $179.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $344.97 / $481.14 / $844.11
| Professional | TC | $344.97 | $481.14 | $844.11 |