- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.10 / $64.59 / $314.20
| Facility | 26 | $55.10 | $64.59 | $314.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.82 / $275.00 / $475.00
| Professional | | $233.82 | $275.00 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.12 / $68.75 / $140.00
| Professional | 26 | $59.12 | $68.75 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $174.69 / $206.25 / $335.00
| Professional | TC | $174.69 | $206.25 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.70 / $231.35 / $317.68
| Professional | | $56.70 | $231.35 | $317.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $55.00 / $88.23
| Facility | 26 | $55.00 | $55.00 | $88.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.61 / $376.97 / $636.10
| Professional | | $195.61 | $376.97 | $636.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.13 / $56.29 / $94.81
| Professional | 26 | $49.13 | $56.29 | $94.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $145.18 / $313.98 / $565.12
| Professional | TC | $145.18 | $313.98 | $565.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $409.92 / $530.79 / $530.79
| Facility | 26 | $409.92 | $530.79 | $530.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.38 / $352.07 / $2,955.62
| Professional | | $226.38 | $352.07 | $2,955.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.97 / $63.07 / $596.05
| Professional | 26 | $48.97 | $63.07 | $596.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.01 / $339.85 / $2,626.86
| Professional | TC | $173.01 | $339.85 | $2,626.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.38 / $299.24 / $543.26
| Professional | | $226.38 | $299.24 | $543.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.97 / $60.49 / $83.61
| Professional | 26 | $48.97 | $60.49 | $83.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.01 / $228.69 / $450.75
| Professional | TC | $173.01 | $228.69 | $450.75 |