- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.05 / $98.05 / $99.88
| Facility | 26 | $98.05 | $98.05 | $99.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.28 / $475.00 / $642.28
| Professional | | $405.28 | $475.00 | $642.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.82 / $140.00 / $168.49
| Professional | 26 | $102.82 | $140.00 | $168.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $302.45 / $335.00 / $473.79
| Professional | TC | $302.45 | $335.00 | $473.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.00 / $1,707.00 / $3,155.00
| Professional | | $1,039.00 | $1,707.00 | $3,155.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $260.00 / $428.00 / $791.00
| Professional | 26 | $260.00 | $428.00 | $791.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $779.00 / $1,279.00 / $2,364.00
| Professional | TC | $779.00 | $1,279.00 | $2,364.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.53 / $829.81 / $1,604.76
| Professional | | $605.53 | $829.81 | $1,604.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.72 / $176.51 / $382.40
| Professional | 26 | $116.72 | $176.51 | $382.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $468.73 / $615.00 / $1,222.35
| Professional | TC | $468.73 | $615.00 | $1,222.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.41 / $885.99 / $2,142.79
| Professional | | $538.41 | $885.99 | $2,142.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.98 / $192.67 / $346.52
| Professional | 26 | $90.98 | $192.67 | $346.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $508.28 / $674.25 / $1,935.98
| Professional | TC | $508.28 | $674.25 | $1,935.98 |