- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.52 / $110.00 / $138.85
| Facility | 26 | $84.52 | $110.00 | $138.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $550.00 / $600.00
| Professional | | $250.00 | $550.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.12 / $110.00 / $145.65
| Professional | 26 | $67.12 | $110.00 | $145.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $187.50 / $393.48 / $480.00
| Professional | TC | $187.50 | $393.48 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.58 / $448.18 / $759.21
| Professional | | $369.58 | $448.18 | $759.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.66 / $125.11 / $159.44
| Professional | 26 | $95.66 | $125.11 | $159.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $273.92 / $315.70 / $599.77
| Professional | TC | $273.92 | $315.70 | $599.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.27 / $74.27 / $78.56
| Professional | 26 | $74.27 | $74.27 | $78.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.89 / $335.10 / $714.75
| Professional | | $167.89 | $335.10 | $714.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.32 / $97.33 / $167.28
| Professional | 26 | $53.32 | $97.33 | $167.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.57 / $228.96 / $606.77
| Professional | TC | $114.57 | $228.96 | $606.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.88 / $400.82 / $717.54
| Professional | | $283.88 | $400.82 | $717.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.45 / $92.09 / $140.16
| Professional | 26 | $69.45 | $92.09 | $140.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $195.06 / $271.95 / $557.28
| Professional | TC | $195.06 | $271.95 | $557.28 |