- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.06 / $110.00 / $129.63
| Facility | 26 | $80.06 | $110.00 | $129.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.00 / $550.00 / $654.86
| Professional | | $330.00 | $550.00 | $654.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.62 / $110.00 / $160.41
| Professional | 26 | $75.62 | $110.00 | $160.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $254.38 / $440.00 / $494.44
| Professional | TC | $254.38 | $440.00 | $494.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.29 / $277.29 / $277.29
| Professional | | $277.29 | $277.29 | $277.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.88 / $523.34 / $708.00
| Professional | | $435.88 | $523.34 | $708.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.07 / $124.71 / $150.57
| Professional | 26 | $90.07 | $124.71 | $150.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $345.81 / $398.63 / $557.44
| Professional | TC | $345.81 | $398.63 | $557.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.94 / $69.94 / $74.26
| Professional | 26 | $69.94 | $69.94 | $74.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.10 / $377.87 / $727.40
| Professional | | $194.10 | $377.87 | $727.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.21 / $91.35 / $156.47
| Professional | 26 | $50.21 | $91.35 | $156.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $143.88 / $282.25 / $604.41
| Professional | TC | $143.88 | $282.25 | $604.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.63 / $420.45 / $787.44
| Professional | | $287.63 | $420.45 | $787.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.01 / $87.31 / $141.24
| Professional | 26 | $65.01 | $87.31 | $141.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.85 / $321.45 / $602.60
| Professional | TC | $213.85 | $321.45 | $602.60 |