- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.52 / $110.00 / $138.36
| Facility | 26 | $84.52 | $110.00 | $138.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.85 / $550.00 / $638.61
| Professional | | $266.85 | $550.00 | $638.61 |
- 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
- $199.73 / $440.00 / $480.00
| Professional | TC | $199.73 | $440.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.77 / $198.77 / $198.77
| Professional | | $198.77 | $198.77 | $198.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.60 / $504.73 / $830.63
| Professional | | $418.60 | $504.73 | $830.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.66 / $125.11 / $158.81
| Professional | 26 | $95.66 | $125.11 | $158.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $322.94 / $372.25 / $671.81
| Professional | TC | $322.94 | $372.25 | $671.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.27 / $74.27 / $78.25
| Professional | 26 | $74.27 | $74.27 | $78.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.24 / $372.64 / $755.46
| Professional | | $188.24 | $372.64 | $755.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.32 / $96.96 / $165.84
| Professional | 26 | $53.32 | $96.96 | $165.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.91 / $269.33 / $606.77
| Professional | TC | $134.91 | $269.33 | $606.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.70 / $413.60 / $790.83
| Professional | | $303.70 | $413.60 | $790.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.26 / $93.36 / $146.13
| Professional | 26 | $69.26 | $93.36 | $146.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.60 / $322.20 / $561.16
| Professional | TC | $233.60 | $322.20 | $561.16 |