- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.93 / $101.74 / $148.10
| Facility | 26 | $71.93 | $101.74 | $148.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.91 / $425.00 / $573.75
| Professional | | $240.91 | $425.00 | $573.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.12 / $110.00 / $154.00
| Professional | 26 | $59.12 | $110.00 | $154.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $185.09 / $299.00 / $433.00
| Professional | TC | $185.09 | $299.00 | $433.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.60 / $63.60 / $63.60
| Facility | 26 | $63.60 | $63.60 | $63.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.21 / $398.55 / $694.44
| Professional | | $249.21 | $398.55 | $694.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.15 / $74.41 / $124.25
| Professional | 26 | $55.15 | $74.41 | $124.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $192.71 / $322.67 / $618.86
| Professional | TC | $192.71 | $322.67 | $618.86 |
- 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
- $242.14 / $514.02 / $866.55
| Professional | | $242.14 | $514.02 | $866.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.42 / $81.26 / $142.28
| Professional | 26 | $50.42 | $81.26 | $142.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $195.28 / $415.00 / $730.00
| Professional | TC | $195.28 | $415.00 | $730.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.19 / $418.19 / $718.15
| Professional | | $234.19 | $418.19 | $718.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.05 / $67.58 / $123.48
| Professional | 26 | $52.05 | $67.58 | $123.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $178.97 / $325.10 / $621.35
| Professional | TC | $178.97 | $325.10 | $621.35 |