- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.48 / $78.05 / $380.65
| Facility | 26 | $66.48 | $78.05 | $380.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.00 / $231.38 / $280.77
| Professional | | $171.00 | $231.38 | $280.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.30 / $63.79 / $81.01
| Professional | 26 | $51.30 | $63.79 | $81.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.70 / $167.59 / $220.00
| Professional | TC | $119.70 | $167.59 | $220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.47 / $213.50 / $293.17
| Professional | | $62.47 | $213.50 | $293.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.41 / $66.41 / $107.03
| Facility | 26 | $66.41 | $66.41 | $107.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.90 / $317.33 / $500.86
| Professional | | $180.90 | $317.33 | $500.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.06 / $67.09 / $103.98
| Professional | 26 | $53.06 | $67.09 | $103.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $127.50 / $259.24 / $399.95
| Professional | TC | $127.50 | $259.24 | $399.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $434.48 / $561.91 / $561.91
| Facility | 26 | $434.48 | $561.91 | $561.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.84 / $315.73 / $2,220.23
| Professional | | $218.84 | $315.73 | $2,220.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.20 / $73.28 / $590.91
| Professional | 26 | $56.20 | $73.28 | $590.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.63 / $275.23 / $1,822.59
| Professional | TC | $162.63 | $275.23 | $1,822.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.84 / $289.27 / $482.71
| Professional | | $218.84 | $289.27 | $482.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.51 / $66.48 / $105.69
| Professional | 26 | $56.51 | $66.48 | $105.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.63 / $205.63 / $367.34
| Professional | TC | $162.63 | $205.63 | $367.34 |