- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.13 / $110.00 / $120.00
| Facility | 26 | $72.13 | $110.00 | $120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.26 / $550.00 / $600.00
| Professional | | $276.26 | $550.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.20 / $110.00 / $144.51
| Professional | 26 | $68.20 | $110.00 | $144.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $206.25 / $422.66 / $480.00
| Professional | TC | $206.25 | $422.66 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.93 / $440.82 / $580.48
| Professional | | $365.93 | $440.82 | $580.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.86 / $106.21 / $134.88
| Professional | 26 | $81.86 | $106.21 | $134.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $284.07 / $327.49 / $445.60
| Professional | TC | $284.07 | $327.49 | $445.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.29 / $63.29 / $66.06
| Professional | 26 | $63.29 | $63.29 | $66.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.19 / $327.69 / $638.66
| Professional | | $163.19 | $327.69 | $638.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.44 / $82.29 / $141.50
| Professional | 26 | $45.44 | $82.29 | $141.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $117.76 / $231.88 / $499.36
| Professional | TC | $117.76 | $231.88 | $499.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.27 / $358.74 / $663.70
| Professional | | $236.27 | $358.74 | $663.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.87 / $75.91 / $127.91
| Professional | 26 | $58.87 | $75.91 | $127.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.65 / $264.79 / $496.39
| Professional | TC | $177.65 | $264.79 | $496.39 |