- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.18 / $60.69 / $60.69
| Facility | 26 | $55.18 | $60.69 | $60.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.51 / $377.37 / $518.22
| Professional | | $323.51 | $377.37 | $518.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.54 / $60.69 / $118.81
| Professional | 26 | $51.54 | $60.69 | $118.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $262.75 / $316.08 / $381.08
| Professional | TC | $262.75 | $316.08 | $381.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.06 / $334.02 / $765.22
| Professional | | $62.06 | $334.02 | $765.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.88 / $63.88 / $63.88
| Facility | 26 | $63.88 | $63.88 | $63.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.10 / $385.39 / $1,325.39
| Professional | | $260.10 | $385.39 | $1,325.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.64 / $70.12 / $212.77
| Professional | 26 | $50.64 | $70.12 | $212.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $180.19 / $324.74 / $1,112.61
| Professional | TC | $180.19 | $324.74 | $1,112.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.48 / $524.48 / $576.92
| Professional | | $524.48 | $524.48 | $576.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.65 / $74.15 / $83.22
| Professional | 26 | $56.65 | $74.15 | $83.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.21 / $259.30 / $455.38
| Professional | | $185.21 | $259.30 | $455.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.79 / $66.31 / $95.14
| Professional | 26 | $43.79 | $66.31 | $95.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $127.77 / $214.62 / $336.80
| Professional | TC | $127.77 | $214.62 | $336.80 |