- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.00 / $64.00 / $191.20
| Facility | 26 | $60.00 | $64.00 | $191.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.39 / $300.00 / $380.51
| Professional | | $185.39 | $300.00 | $380.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.00 / $94.06 / $176.08
| Professional | 26 | $60.00 | $94.06 | $176.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $112.33 / $216.60 / $240.00
| Professional | TC | $112.33 | $216.60 | $240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.29 / $356.26 / $442.35
| Professional | | $282.29 | $356.26 | $442.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $132.78 / $183.89 / $219.18
| Professional | 26 | $132.78 | $183.89 | $219.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $149.51 / $172.37 / $223.17
| Professional | TC | $149.51 | $172.37 | $223.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.91 / $103.91 / $109.55
| Professional | 26 | $103.91 | $103.91 | $109.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.18 / $463.51 / $823.65
| Professional | | $256.18 | $463.51 | $823.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.59 / $121.77 / $227.96
| Professional | 26 | $74.59 | $121.77 | $227.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $181.60 / $316.74 / $595.67
| Professional | TC | $181.60 | $316.74 | $595.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.81 / $483.54 / $749.35
| Professional | | $319.81 | $483.54 | $749.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.24 / $125.35 / $204.13
| Professional | 26 | $85.24 | $125.35 | $204.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $235.20 / $362.34 / $549.79
| Professional | TC | $235.20 | $362.34 | $549.79 |