- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $79.43 / $117.49
| Facility | 26 | $79.43 | $79.43 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $426.58 / $575.44
| Professional | | $346.74 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $61.66 / $93.33
| Professional | 26 | $52.48 | $61.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $28.18 / $95.50 / $95.50
| Professional | 52 | $28.18 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $363.08 / $478.63
| Professional | TC | $288.40 | $363.08 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $575.44
| Professional | | $436.52 | $436.52 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $67.61 / $89.13
| Professional | 26 | $67.61 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $363.08 / $363.08 / $478.63
| Professional | TC | $363.08 | $363.08 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $812.83
| Professional | | $416.87 | $575.44 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $93.33 / $138.04
| Professional | 26 | $60.26 | $93.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $363.08 / $489.78 / $691.83
| Professional | TC | $363.08 | $489.78 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $724.44
| Professional | | $346.74 | $478.63 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $75.86 / $123.03
| Professional | 26 | $53.70 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $407.38 / $602.56
| Professional | TC | $288.40 | $407.38 | $602.56 |