- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $142.53 / $184.58 / $184.58
| Facility | 26 | $142.53 | $184.58 | $184.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.94 / $556.90 / $673.70
| Professional | | $317.94 | $556.90 | $673.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.00 / $184.58 / $211.91
| Professional | 26 | $85.00 | $184.58 | $211.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $206.25 / $372.31 / $455.68
| Professional | TC | $206.25 | $372.31 | $455.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.28 / $421.28 / $421.28
| Professional | | $421.28 | $421.28 | $421.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.75 / $93.71 / $112.44
| Professional | 26 | $89.75 | $93.71 | $112.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.29 / $334.95 / $718.62
| Professional | | $222.29 | $334.95 | $718.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.72 / $125.65 / $148.27
| Professional | 26 | $91.72 | $125.65 | $148.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $176.43 / $265.85 / $570.35
| Professional | TC | $176.43 | $265.85 | $570.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.31 / $550.00 / $1,089.31
| Professional | | $301.31 | $550.00 | $1,089.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.47 / $165.00 / $269.62
| Professional | 26 | $98.47 | $165.00 | $269.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $203.69 / $385.00 / $808.69
| Professional | TC | $203.69 | $385.00 | $808.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.47 / $426.58 / $908.98
| Professional | | $328.47 | $426.58 | $908.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.71 / $125.65 / $180.02
| Professional | 26 | $97.71 | $125.65 | $180.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $228.15 / $314.20 / $731.86
| Professional | TC | $228.15 | $314.20 | $731.86 |