- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.00 / $60.00 / $122.57
| Facility | 26 | $60.00 | $60.00 | $122.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $342.85 / $661.59
| Professional | | $300.00 | $342.85 | $661.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.00 / $68.56 / $112.43
| Professional | 26 | $60.00 | $68.56 | $112.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $240.00 / $274.27 / $549.13
| Professional | TC | $240.00 | $274.27 | $549.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.15 / $496.45 / $790.19
| Professional | | $466.15 | $496.45 | $790.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.02 / $109.77 / $144.07
| Professional | 26 | $92.02 | $109.77 | $144.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $365.05 / $417.61 / $646.14
| Professional | TC | $365.05 | $417.61 | $646.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $66.43 / $66.43
| Professional | 26 | $40.00 | $66.43 | $66.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.40 / $357.10 / $664.02
| Professional | | $220.40 | $357.10 | $664.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.35 / $73.31 / $162.44
| Professional | 26 | $45.35 | $73.31 | $162.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $176.08 / $300.33 / $540.37
| Professional | TC | $176.08 | $300.33 | $540.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.54 / $460.50 / $686.10
| Professional | | $320.54 | $460.50 | $686.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.97 / $86.50 / $153.31
| Professional | 26 | $67.97 | $86.50 | $153.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $259.95 / $355.09 / $516.64
| Professional | TC | $259.95 | $355.09 | $516.64 |