- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $160.75 / $170.20 / $257.62
| Facility | 26 | $160.75 | $170.20 | $257.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.47 / $273.66 / $583.84
| Professional | | $229.47 | $273.66 | $583.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.72 / $160.60 / $272.10
| Professional | 26 | $141.72 | $160.60 | $272.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.48 / $104.53 / $152.46
| Professional | TC | $85.48 | $104.53 | $152.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.96 / $261.73 / $436.27
| Professional | | $215.96 | $261.73 | $436.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $130.36 / $161.57 / $270.77
| Professional | 26 | $130.36 | $161.57 | $270.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.75 / $102.36 / $167.78
| Professional | TC | $82.75 | $102.36 | $167.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $176.41 / $176.41 / $176.41
| Facility | 26 | $176.41 | $176.41 | $176.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.76 / $350.13 / $599.91
| Professional | | $227.76 | $350.13 | $599.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $158.60 / $222.98 / $379.30
| Professional | 26 | $158.60 | $222.98 | $379.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $95.36 / $141.60 / $238.51
| Professional | TC | $95.36 | $141.60 | $238.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.72 / $322.94 / $558.25
| Professional | | $245.72 | $322.94 | $558.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $148.11 / $203.68 / $338.62
| Professional | 26 | $148.11 | $203.68 | $338.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $93.87 / $128.55 / $208.60
| Professional | TC | $93.87 | $128.55 | $208.60 |