- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.82 / $106.48 / $143.74
| Facility | 26 | $84.82 | $106.48 | $143.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.00 / $317.08 / $475.00
| Professional | | $275.00 | $317.08 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.75 / $106.48 / $141.00
| Professional | 26 | $68.75 | $106.48 | $141.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $181.74 / $205.23 / $340.00
| Professional | TC | $181.74 | $205.23 | $340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.74 / $134.97 / $166.96
| Professional | | $126.74 | $134.97 | $166.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.48 / $77.39 / $102.96
| Professional | 26 | $51.48 | $77.39 | $102.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.97 / $232.01 / $497.76
| Professional | | $153.97 | $232.01 | $497.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.44 / $160.88 / $189.84
| Professional | 26 | $117.44 | $160.88 | $189.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $95.25 / $143.53 / $307.92
| Professional | TC | $95.25 | $143.53 | $307.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.19 / $373.90 / $790.41
| Professional | | $158.19 | $373.90 | $790.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.52 / $102.37 / $207.38
| Professional | 26 | $56.52 | $102.37 | $207.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $101.52 / $245.42 / $655.22
| Professional | TC | $101.52 | $245.42 | $655.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.38 / $221.51 / $697.95
| Professional | | $165.38 | $221.51 | $697.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.93 / $73.09 / $106.78
| Professional | 26 | $57.93 | $73.09 | $106.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $111.15 / $152.68 / $594.37
| Professional | TC | $111.15 | $152.68 | $594.37 |