- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $237.81 / $360.08 / $388.88
| Facility | 26 | $237.81 | $360.08 | $388.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.95 / $695.92 / $808.44
| Professional | | $504.95 | $695.92 | $808.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $198.28 / $332.29 / $396.09
| Professional | 26 | $198.28 | $332.29 | $396.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $306.66 / $363.63 / $449.00
| Professional | TC | $306.66 | $363.63 | $449.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.33 / $554.33 / $554.33
| Professional | | $554.33 | $554.33 | $554.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $176.59 / $248.63 / $270.25
| Professional | 26 | $176.59 | $248.63 | $270.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.91 / $709.54 / $863.95
| Professional | | $551.91 | $709.54 | $863.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $262.97 / $344.67 / $408.97
| Professional | 26 | $262.97 | $344.67 | $408.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.95 / $364.87 / $463.00
| Professional | TC | $288.95 | $364.87 | $463.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $206.42 / $226.91 / $226.91
| Professional | 26 | $206.42 | $226.91 | $226.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.14 / $494.18 / $1,071.58
| Professional | | $316.14 | $494.18 | $1,071.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $154.13 / $233.04 / $393.84
| Professional | 26 | $154.13 | $233.04 | $393.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.01 / $257.23 / $547.82
| Professional | TC | $162.01 | $257.23 | $547.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.44 / $576.01 / $1,228.50
| Professional | | $390.44 | $576.01 | $1,228.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $178.29 / $245.70 / $388.15
| Professional | 26 | $178.29 | $245.70 | $388.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $193.29 / $296.82 / $910.62
| Professional | TC | $193.29 | $296.82 | $910.62 |