- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.39 / $110.00 / $171.48
| Facility | 26 | $104.39 | $110.00 | $171.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.08 / $550.00 / $819.91
| Professional | | $402.08 | $550.00 | $819.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.26 / $120.00 / $209.14
| Professional | 26 | $100.26 | $120.00 | $209.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $282.87 / $440.00 / $599.77
| Professional | TC | $282.87 | $440.00 | $599.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.33 / $341.33 / $341.33
| Professional | | $341.33 | $341.33 | $341.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.47 / $97.01 / $232.83
| Professional | 26 | $76.47 | $97.01 | $232.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.25 / $643.54 / $867.93
| Professional | | $534.25 | $643.54 | $867.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $119.35 / $165.24 / $196.75
| Professional | 26 | $119.35 | $165.24 | $196.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $414.90 / $478.31 / $671.17
| Professional | TC | $414.90 | $478.31 | $671.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.22 / $93.22 / $98.02
| Professional | 26 | $93.22 | $93.22 | $98.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.93 / $465.36 / $975.52
| Professional | | $238.93 | $465.36 | $975.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.91 / $120.56 / $204.32
| Professional | 26 | $66.91 | $120.56 | $204.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $172.02 / $338.67 / $757.29
| Professional | TC | $172.02 | $338.67 | $757.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.37 / $524.17 / $1,110.61
| Professional | | $344.37 | $524.17 | $1,110.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.05 / $114.08 / $181.50
| Professional | 26 | $86.05 | $114.08 | $181.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $258.32 / $388.57 / $792.70
| Professional | TC | $258.32 | $388.57 | $792.70 |