- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.66 / $78.66 / $78.66
| Facility | 26 | $78.66 | $78.66 | $78.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.14 / $754.91 / $876.03
| Professional | | $584.14 | $754.91 | $876.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.28 / $91.96 / $97.76
| Professional | 26 | $65.28 | $91.96 | $97.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $518.86 / $662.14 / $778.28
| Professional | TC | $518.86 | $662.14 | $778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.99 / $846.65 / $1,162.57
| Professional | | $117.99 | $846.65 | $1,162.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.19 / $812.55 / $1,368.50
| Professional | | $685.19 | $812.55 | $1,368.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.11 / $96.32 / $162.22
| Professional | 26 | $86.11 | $96.32 | $162.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $607.22 / $716.23 / $1,204.65
| Professional | TC | $607.22 | $716.23 | $1,204.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $229.45 / $432.95 / $432.95
| Facility | 26 | $229.45 | $432.95 | $432.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.50 / $944.37 / $1,875.94
| Professional | | $775.50 | $944.37 | $1,875.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.73 / $103.79 / $237.56
| Professional | 26 | $83.73 | $103.79 | $237.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $680.79 / $803.26 / $1,852.52
| Professional | TC | $680.79 | $803.26 | $1,852.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.52 / $907.05 / $1,756.19
| Professional | | $764.52 | $907.05 | $1,756.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.73 / $101.04 / $200.22
| Professional | 26 | $83.73 | $101.04 | $200.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $680.79 / $759.51 / $1,670.49
| Professional | TC | $680.79 | $759.51 | $1,670.49 |