- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.81 / $110.00 / $120.00
| Facility | 26 | $65.81 | $110.00 | $120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $522.50 / $600.00
| Professional | | $250.00 | $522.50 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.00 / $110.00 / $140.00
| Professional | 26 | $64.00 | $110.00 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $187.50 / $348.53 / $440.00
| Professional | TC | $187.50 | $348.53 | $440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.57 / $377.64 / $644.12
| Professional | | $312.57 | $377.64 | $644.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.70 / $103.45 / $123.98
| Professional | 26 | $74.70 | $103.45 | $123.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $237.86 / $274.19 / $520.16
| Professional | TC | $237.86 | $274.19 | $520.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.77 / $57.77 / $61.08
| Professional | 26 | $57.77 | $57.77 | $61.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.86 / $278.49 / $588.11
| Professional | | $140.86 | $278.49 | $588.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.48 / $71.09 / $128.74
| Professional | 26 | $41.48 | $71.09 | $128.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $99.39 / $194.14 / $503.81
| Professional | TC | $99.39 | $194.14 | $503.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.46 / $327.36 / $661.74
| Professional | | $230.46 | $327.36 | $661.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.88 / $73.68 / $115.52
| Professional | 26 | $53.88 | $73.68 | $115.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $172.84 / $235.60 / $439.32
| Professional | TC | $172.84 | $235.60 | $439.32 |