- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.76 / $76.76 / $358.86
| Facility | 26 | $76.76 | $76.76 | $358.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.41 / $434.96 / $595.25
| Professional | | $382.41 | $434.96 | $595.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.42 / $58.34 / $80.90
| Professional | 26 | $50.42 | $58.34 | $80.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $331.99 / $378.80 / $514.35
| Professional | TC | $331.99 | $378.80 | $514.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.05 / $484.76 / $744.81
| Professional | | $412.05 | $484.76 | $744.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.87 / $61.24 / $67.48
| Professional | 26 | $42.87 | $61.24 | $67.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $296.45 / $423.52 / $423.52
| Professional | TC | $296.45 | $423.52 | $423.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.17 / $599.22 / $1,146.48
| Professional | | $437.17 | $599.22 | $1,146.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.52 / $70.02 / $145.00
| Professional | 26 | $58.52 | $70.02 | $145.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $378.65 / $529.20 / $997.04
| Professional | TC | $378.65 | $529.20 | $997.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.58 / $612.10 / $774.96
| Professional | | $392.58 | $612.10 | $774.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.29 / $91.39 / $109.22
| Professional | 26 | $59.29 | $91.39 | $109.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $358.31 / $516.40 / $667.56
| Professional | TC | $358.31 | $516.40 | $667.56 |