- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.00 / $60.04 / $97.68
| Facility | 26 | $60.00 | $60.04 | $97.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.63 / $300.00 / $347.94
| Professional | | $178.63 | $300.00 | $347.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.30 / $60.00 / $112.83
| Professional | 26 | $51.30 | $60.00 | $112.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.70 / $240.00 / $256.00
| Professional | TC | $119.70 | $240.00 | $256.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.91 / $63.26 / $106.71
| Professional | 26 | $53.91 | $63.26 | $106.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.12 / $283.23 / $429.01
| Professional | | $232.12 | $283.23 | $429.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.03 / $94.12 / $112.31
| Professional | 26 | $68.03 | $94.12 | $112.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $164.09 / $189.11 / $316.70
| Professional | TC | $164.09 | $189.11 | $316.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.57 / $52.57 / $55.45
| Professional | 26 | $52.57 | $52.57 | $55.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.80 / $207.80 / $425.59
| Professional | | $106.80 | $207.80 | $425.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.74 / $64.69 / $117.33
| Professional | 26 | $37.74 | $64.69 | $117.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.06 / $134.47 / $318.87
| Professional | TC | $69.06 | $134.47 | $318.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.55 / $228.92 / $425.61
| Professional | | $168.55 | $228.92 | $425.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.92 / $65.05 / $102.73
| Professional | 26 | $47.92 | $65.05 | $102.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $116.88 / $154.50 / $290.36
| Professional | TC | $116.88 | $154.50 | $290.36 |