- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.47 / $52.47 / $53.47
| Facility | 26 | $52.47 | $52.47 | $53.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.72 / $221.00 / $348.41
| Professional | | $158.72 | $221.00 | $348.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.07 / $55.67 / $73.84
| Professional | 26 | $50.07 | $55.67 | $73.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $107.27 / $154.96 / $292.74
| Professional | TC | $107.27 | $154.96 | $292.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.00 / $727.00 / $727.00
| Professional | | $442.00 | $727.00 | $727.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $140.00 / $230.00 / $230.00
| Professional | 26 | $140.00 | $230.00 | $230.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $302.00 / $497.00 / $497.00
| Professional | TC | $302.00 | $497.00 | $497.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.09 / $359.49 / $687.35
| Professional | | $252.09 | $359.49 | $687.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.17 / $95.53 / $166.50
| Professional | 26 | $63.17 | $95.53 | $166.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $186.13 / $264.45 / $481.08
| Professional | TC | $186.13 | $264.45 | $481.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.89 / $379.62 / $887.69
| Professional | | $257.89 | $379.62 | $887.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.39 / $106.54 / $188.10
| Professional | 26 | $49.39 | $106.54 | $188.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.51 / $265.38 / $708.40
| Professional | TC | $208.51 | $265.38 | $708.40 |