- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.17 / $88.60 / $113.17
| Facility | 26 | $80.17 | $88.60 | $113.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.49 / $536.11 / $725.20
| Professional | | $463.49 | $536.11 | $725.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.28 / $85.00 / $103.07
| Professional | 26 | $64.28 | $85.00 | $103.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $399.20 / $451.11 / $622.12
| Professional | TC | $399.20 | $451.11 | $622.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.69 / $539.28 / $892.24
| Professional | | $506.69 | $539.28 | $892.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.99 / $100.75 / $131.51
| Professional | 26 | $85.99 | $100.75 | $131.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $413.98 / $473.61 / $760.73
| Professional | TC | $413.98 | $473.61 | $760.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.97 / $60.97 / $60.97
| Professional | 26 | $60.97 | $60.97 | $60.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.58 / $461.92 / $920.49
| Professional | | $258.58 | $461.92 | $920.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.83 / $68.56 / $144.56
| Professional | 26 | $43.83 | $68.56 | $144.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $214.76 / $379.57 / $775.93
| Professional | TC | $214.76 | $379.57 | $775.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.27 / $507.78 / $801.15
| Professional | | $426.27 | $507.78 | $801.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.15 / $75.94 / $126.95
| Professional | 26 | $60.15 | $75.94 | $126.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $363.59 / $434.16 / $673.79
| Professional | TC | $363.59 | $434.16 | $673.79 |