- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.12 / $64.12 / $117.37
| Facility | 26 | $64.12 | $64.12 | $117.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.97 / $447.11 / $447.11
| Professional | | $303.97 | $447.11 | $447.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.50 / $37.99 / $37.99
| Professional | 26 | $35.50 | $37.99 | $37.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $268.47 / $409.12 / $409.12
| Professional | TC | $268.47 | $409.12 | $409.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.97 / $407.97 / $957.02
| Professional | | $407.97 | $407.97 | $957.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.77 / $46.81 / $65.48
| Professional | 26 | $32.77 | $46.81 | $65.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $252.81 / $306.99 / $361.16
| Professional | TC | $252.81 | $306.99 | $361.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.15 / $596.45 / $744.20
| Professional | | $232.15 | $596.45 | $744.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.72 / $68.67 / $83.45
| Professional | 26 | $24.72 | $68.67 | $83.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $207.44 / $530.12 / $675.52
| Professional | TC | $207.44 | $530.12 | $675.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.97 / $563.66 / $863.73
| Professional | | $198.97 | $563.66 | $863.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.02 / $58.90 / $79.70
| Professional | 26 | $24.02 | $58.90 | $79.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $176.04 / $501.53 / $784.03
| Professional | TC | $176.04 | $501.53 | $784.03 |