- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.79 / $80.79 / $82.32
| Facility | 26 | $80.79 | $80.79 | $82.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.12 / $443.37 / $475.00
| Professional | | $279.12 | $443.37 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.16 / $139.52 / $140.00
| Professional | 26 | $85.16 | $139.52 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $139.56 / $221.69 / $237.50
| Professional | 52 | $139.56 | $221.69 | $237.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $193.96 / $303.85 / $335.00
| Professional | TC | $193.96 | $303.85 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.00 / $1,187.00 / $2,193.00
| Professional | | $722.00 | $1,187.00 | $2,193.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $216.00 / $355.00 / $656.00
| Professional | 26 | $216.00 | $355.00 | $656.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $506.00 / $832.00 / $1,537.00
| Professional | TC | $506.00 | $832.00 | $1,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.16 / $627.24 / $1,240.00
| Professional | | $418.16 | $627.24 | $1,240.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $96.90 / $146.54 / $317.98
| Professional | 26 | $96.90 | $146.54 | $317.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $298.61 / $450.00 / $868.00
| Professional | TC | $298.61 | $450.00 | $868.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.60 / $605.29 / $1,705.00
| Professional | | $460.60 | $605.29 | $1,705.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.95 / $160.36 / $289.31
| Professional | 26 | $75.95 | $160.36 | $289.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $344.96 / $429.06 / $1,430.01
| Professional | TC | $344.96 | $429.06 | $1,430.01 |