- 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
- $351.78 / $550.00 / $696.45
| Professional | | $351.78 | $550.00 | $696.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.76 / $110.00 / $174.18
| Professional | 26 | $82.76 | $110.00 | $174.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $267.18 / $440.00 / $522.27
| Professional | TC | $267.18 | $440.00 | $522.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.63 / $561.99 / $754.26
| Professional | | $467.63 | $561.99 | $754.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.84 / $136.91 / $164.58
| Professional | 26 | $98.84 | $136.91 | $164.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $368.79 / $425.07 / $589.67
| Professional | TC | $368.79 | $425.07 | $589.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.09 / $77.09 / $81.53
| Professional | 26 | $77.09 | $77.09 | $81.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.64 / $398.22 / $734.54
| Professional | | $209.64 | $398.22 | $734.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.35 / $96.85 / $172.17
| Professional | 26 | $55.35 | $96.85 | $172.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $154.29 / $286.54 / $622.53
| Professional | TC | $154.29 | $286.54 | $622.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.31 / $433.96 / $751.65
| Professional | | $295.31 | $433.96 | $751.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.53 / $94.05 / $148.34
| Professional | 26 | $71.53 | $94.05 | $148.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.25 / $332.67 / $613.86
| Professional | TC | $223.25 | $332.67 | $613.86 |