- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $525.44 / $525.44 / $525.44
| Facility | 26 | $525.44 | $525.44 | $525.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.05 / $585.09 / $600.00
| Professional | | $297.05 | $585.09 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.80 / $124.36 / $180.00
| Professional | 26 | $87.80 | $124.36 | $180.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $209.25 / $420.00 / $469.92
| Professional | TC | $209.25 | $420.00 | $469.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.62 / $396.02 / $950.00
| Professional | | $336.62 | $396.02 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.59 / $116.57 / $162.63
| Professional | 26 | $81.59 | $116.57 | $162.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $195.62 / $279.45 / $318.61
| Professional | TC | $195.62 | $279.45 | $318.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.98 / $569.61 / $803.71
| Professional | | $309.98 | $569.61 | $803.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.98 / $164.64 / $175.81
| Professional | 26 | $75.98 | $164.64 | $175.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $240.91 / $404.97 / $630.39
| Professional | TC | $240.91 | $404.97 | $630.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.11 / $493.55 / $696.78
| Professional | | $268.11 | $493.55 | $696.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.51 / $100.46 / $173.18
| Professional | 26 | $77.51 | $100.46 | $173.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.93 / $333.16 / $596.32
| Professional | TC | $213.93 | $333.16 | $596.32 |