- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.94 / $110.00 / $142.91
| Facility | 26 | $86.94 | $110.00 | $142.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.98 / $550.00 / $695.17
| Professional | | $346.98 | $550.00 | $695.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.60 / $110.00 / $174.18
| Professional | 26 | $84.60 | $110.00 | $174.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $260.04 / $440.00 / $520.99
| Professional | TC | $260.04 | $440.00 | $520.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.51 / $564.14 / $752.35
| Professional | | $469.51 | $564.14 | $752.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.84 / $129.04 / $163.96
| Professional | 26 | $98.84 | $129.04 | $163.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $370.67 / $427.22 / $588.40
| Professional | TC | $370.67 | $427.22 | $588.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.37 / $77.37 / $80.92
| Professional | 26 | $77.37 | $77.37 | $80.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.64 / $391.18 / $800.00
| Professional | | $210.64 | $391.18 | $800.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.55 / $95.22 / $170.14
| Professional | 26 | $55.55 | $95.22 | $170.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $155.09 / $288.02 / $619.55
| Professional | TC | $155.09 | $288.02 | $619.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.26 / $434.52 / $751.05
| Professional | | $293.26 | $434.52 | $751.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.53 / $97.32 / $153.53
| Professional | 26 | $71.53 | $97.32 | $153.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $221.73 / $335.69 / $630.28
| Professional | TC | $221.73 | $335.69 | $630.28 |