- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $102.33 / $138.04
| Facility | 26 | $87.10 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $933.25
| Professional | | $346.74 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $120.23 / $223.87
| Professional | 26 | $83.18 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $338.84 / $616.60
| Professional | TC | $257.04 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Professional | 26 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $831.76
| Professional | | $398.11 | $537.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $114.82 / $181.97
| Professional | 26 | $93.33 | $114.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $309.03 / $416.87 / $645.65
| Professional | TC | $309.03 | $416.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,047.13
| Professional | | $331.13 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $114.82 / $223.87
| Professional | 26 | $74.13 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.19 / $446.68 / $851.14
| Professional | TC | $251.19 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $794.33
| Professional | | $346.74 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $93.33 / $162.18
| Professional | 26 | $75.86 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $398.11 / $645.65
| Professional | TC | $263.03 | $398.11 | $645.65 |