- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Facility | 26 | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $660.69
| Professional | | $245.47 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $114.82 / $208.93
| Professional | 26 | $79.43 | $114.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $257.04 / $426.58
| Professional | TC | $162.18 | $257.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $1,230.27
| Professional | | $794.33 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $218.78 / $338.84 / $338.84
| Professional | 26 | $218.78 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $575.44 / $891.25 / $891.25
| Professional | TC | $575.44 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $1,148.15
| Professional | | $436.52 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $181.97 / $323.59
| Professional | 26 | $104.71 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $309.03 / $446.68 / $870.96
| Professional | TC | $309.03 | $446.68 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $616.60 / $1,548.82
| Professional | | $416.87 | $616.60 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $162.18 / $295.12
| Professional | 26 | $81.28 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $331.13 / $446.68 / $1,258.93
| Professional | TC | $331.13 | $446.68 | $1,258.93 |