- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $318.20 / $318.20 / $318.20
| Facility | 26 | $318.20 | $318.20 | $318.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.18 / $293.82 / $317.56
| Professional | | $293.18 | $293.82 | $317.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.47 / $46.64 / $48.50
| Professional | 26 | $43.47 | $46.64 | $48.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $246.54 / $250.34 / $269.07
| Professional | TC | $246.54 | $250.34 | $269.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.36 / $357.36 / $626.69
| Professional | | $357.36 | $357.36 | $626.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.88 / $58.40 / $95.52
| Professional | 26 | $40.88 | $58.40 | $95.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $209.27 / $298.95 / $298.95
| Professional | TC | $209.27 | $298.95 | $298.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.25 / $692.33 / $793.63
| Professional | | $372.25 | $692.33 | $793.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.84 / $100.49 / $106.47
| Professional | 26 | $60.84 | $100.49 | $106.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $311.41 / $586.15 / $688.63
| Professional | TC | $311.41 | $586.15 | $688.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.99 / $373.75 / $575.98
| Professional | | $251.99 | $373.75 | $575.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.74 / $60.04 / $88.54
| Professional | 26 | $38.74 | $60.04 | $88.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.25 / $363.38 / $487.44
| Professional | TC | $213.25 | $363.38 | $487.44 |