- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.26 / $60.00 / $92.51
| Facility | 26 | $56.26 | $60.00 | $92.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.78 / $300.00 / $450.00
| Professional | | $239.78 | $300.00 | $450.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.07 / $60.00 / $112.71
| Professional | 26 | $50.07 | $60.00 | $112.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $179.25 / $240.00 / $333.10
| Professional | TC | $179.25 | $240.00 | $333.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.27 / $57.30 / $124.49
| Professional | 26 | $40.27 | $57.30 | $124.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.89 / $366.71 / $421.97
| Professional | | $311.89 | $366.71 | $421.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.42 / $89.19 / $107.19
| Professional | 26 | $64.42 | $89.19 | $107.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $247.16 / $273.56 / $317.52
| Professional | TC | $247.16 | $273.56 | $317.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.80 / $49.80 / $52.80
| Professional | 26 | $49.80 | $49.80 | $52.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.93 / $261.72 / $451.22
| Professional | | $140.93 | $261.72 | $451.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.76 / $64.87 / $110.16
| Professional | 26 | $35.76 | $64.87 | $110.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $105.17 / $189.00 / $340.69
| Professional | TC | $105.17 | $189.00 | $340.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.53 / $270.35 / $449.82
| Professional | | $177.53 | $270.35 | $449.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.41 / $62.42 / $99.64
| Professional | 26 | $45.41 | $62.42 | $99.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $131.31 / $205.24 / $351.60
| Professional | TC | $131.31 | $205.24 | $351.60 |