- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.95 / $65.95 / $67.19
| Facility | 26 | $65.95 | $65.95 | $67.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.77 / $322.64 / $475.00
| Professional | | $202.77 | $322.64 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.88 / $114.47 / $140.00
| Professional | 26 | $69.88 | $114.47 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $132.88 / $208.19 / $335.00
| Professional | TC | $132.88 | $208.19 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.00 / $860.00 / $1,589.00
| Professional | | $524.00 | $860.00 | $1,589.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $177.00 / $290.00 / $537.00
| Professional | 26 | $177.00 | $290.00 | $537.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $347.00 / $570.00 / $1,052.00
| Professional | TC | $347.00 | $570.00 | $1,052.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.30 / $523.03 / $1,000.00
| Professional | | $320.30 | $523.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.08 / $119.63 / $261.32
| Professional | 26 | $79.08 | $119.63 | $261.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $212.23 / $375.72 / $726.04
| Professional | TC | $212.23 | $375.72 | $726.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.04 / $441.61 / $1,369.51
| Professional | | $355.04 | $441.61 | $1,369.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.81 / $128.97 / $225.21
| Professional | 26 | $61.81 | $128.97 | $225.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $238.55 / $315.23 / $1,145.10
| Professional | TC | $238.55 | $315.23 | $1,145.10 |