- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.58 / $68.58 / $68.58
| Facility | 26 | $68.58 | $68.58 | $68.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.40 / $451.62 / $470.84
| Professional | | $389.40 | $451.62 | $470.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.82 / $65.31 / $68.58
| Professional | 26 | $56.82 | $65.31 | $68.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $332.58 / $386.31 / $406.35
| Professional | TC | $332.58 | $386.31 | $406.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.84 / $137.94 / $205.06
| Professional | 26 | $131.84 | $137.94 | $205.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $747.55 / $972.04 / $1,539.12
| Professional | TC | $747.55 | $972.04 | $1,539.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.68 / $602.41 / $1,539.12
| Professional | | $337.68 | $602.41 | $1,539.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.89 / $96.40 / $205.06
| Professional | 26 | $42.89 | $96.40 | $205.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $294.79 / $492.54 / $810.22
| Professional | TC | $294.79 | $492.54 | $810.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $593.94 / $945.83
| Professional | | $500.00 | $593.94 | $945.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.62 / $83.62 / $143.08
| Professional | 26 | $75.62 | $83.62 | $143.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $433.77 / $510.31 / $810.22
| Professional | TC | $433.77 | $510.31 | $810.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.51 / $857.72 / $1,723.56
| Professional | | $591.51 | $857.72 | $1,723.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.00 / $123.98 / $244.19
| Professional | 26 | $84.00 | $123.98 | $244.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $462.10 / $631.41 / $1,479.37
| Professional | TC | $462.10 | $631.41 | $1,479.37 |