- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $223.87 / $275.42
| Facility | 26 | $100.00 | $223.87 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $660.69
| Professional | | $165.96 | $275.42 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $72.44 / $199.53
| Professional | 26 | $51.29 | $72.44 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.82 / $194.98 / $407.38
| Professional | TC | $114.82 | $194.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $467.74 / $724.44
| Professional | | $194.98 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $117.49 / $154.88
| Professional | 26 | $56.23 | $117.49 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.04 / $316.23 / $588.84
| Professional | TC | $138.04 | $316.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $426.58 / $616.60
| Professional | | $229.09 | $426.58 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $85.11 / $165.96
| Professional | 26 | $57.54 | $85.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $158.49 / $338.84 / $489.78
| Professional | TC | $158.49 | $338.84 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $416.87 / $489.78
| Professional | | $239.88 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $75.86 / $91.20
| Professional | 26 | $63.10 | $75.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.90 / $177.83 / $338.84
| Professional | TC | $134.90 | $177.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $93.33 / $114.82
| Professional | | $81.28 | $93.33 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $288.40 / $524.81
| Professional | | $169.82 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $69.18 / $147.91
| Professional | 26 | $50.12 | $69.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $117.49 / $199.53 / $371.54
| Professional | TC | $117.49 | $199.53 | $371.54 |