- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $173.78 / $239.88 / $467.74
| Facility | 26 | $173.78 | $239.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $912.01
| Professional | | $263.03 | $338.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $169.82 / $204.17 / $537.03
| Professional | 26 | $169.82 | $204.17 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $93.33 / $114.82 / $199.53
| Professional | TC | $93.33 | $114.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $575.44
| Professional | | $218.78 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $204.17 / $363.08
| Professional | 26 | $141.25 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.11 / $120.23 / $234.42
| Professional | TC | $85.11 | $120.23 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $239.88 / $645.65
| Facility | 26 | $44.67 | $239.88 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $891.25
| Professional | | $288.40 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $275.42 / $562.34
| Professional | 26 | $181.97 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $102.33 / $165.96 / $331.13
| Professional | TC | $102.33 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $660.69
| Professional | | $263.03 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $229.09 / $416.87
| Professional | 26 | $162.18 | $229.09 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $97.72 / $138.04 / $251.19
| Professional | TC | $97.72 | $138.04 | $251.19 |