- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.98 / $98.72 / $166.16
| Facility | 26 | $65.98 | $98.72 | $166.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.73 / $425.00 / $600.00
| Professional | | $236.73 | $425.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.39 / $125.48 / $189.00
| Professional | 26 | $60.39 | $125.48 | $189.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $176.35 / $306.33 / $440.00
| Professional | TC | $176.35 | $306.33 | $440.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.97 / $63.97 / $63.97
| Facility | 26 | $63.97 | $63.97 | $63.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.87 / $362.85 / $691.20
| Professional | | $235.87 | $362.85 | $691.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.49 / $75.87 / $124.64
| Professional | 26 | $56.49 | $75.87 | $124.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $177.66 / $291.24 / $583.70
| Professional | TC | $177.66 | $291.24 | $583.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.84 / $64.84 / $64.84
| Facility | 26 | $64.84 | $64.84 | $64.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.32 / $512.11 / $870.16
| Professional | | $239.32 | $512.11 | $870.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.42 / $82.07 / $140.24
| Professional | 26 | $50.42 | $82.07 | $140.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $182.06 / $388.40 / $709.71
| Professional | TC | $182.06 | $388.40 | $709.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.12 / $406.42 / $744.10
| Professional | | $224.12 | $406.42 | $744.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.15 / $67.70 / $125.42
| Professional | 26 | $52.15 | $67.70 | $125.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $165.69 / $302.72 / $615.50
| Professional | TC | $165.69 | $302.72 | $615.50 |