- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $237.81 / $360.08 / $396.09
| Facility | 26 | $237.81 | $360.08 | $396.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.44 / $695.41 / $807.80
| Professional | | $427.44 | $695.41 | $807.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $188.34 / $332.29 / $396.09
| Professional | 26 | $188.34 | $332.29 | $396.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.11 / $363.12 / $430.21
| Professional | TC | $239.11 | $363.12 | $430.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.71 / $542.71 / $542.71
| Professional | | $542.71 | $542.71 | $542.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $176.59 / $248.63 / $348.36
| Professional | 26 | $176.59 | $248.63 | $348.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.64 / $692.67 / $893.76
| Professional | | $538.64 | $692.67 | $893.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $263.33 / $345.15 / $409.72
| Professional | 26 | $263.33 | $345.15 | $409.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $275.30 / $355.76 / $492.07
| Professional | TC | $275.30 | $355.76 | $492.07 |
- 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
- $309.51 / $496.55 / $827.82
| Professional | | $309.51 | $496.55 | $827.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $154.13 / $232.54 / $440.60
| Professional | 26 | $154.13 | $232.54 | $440.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $155.38 / $252.09 / $546.26
| Professional | TC | $155.38 | $252.09 | $546.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.17 / $532.19 / $881.81
| Professional | | $386.17 | $532.19 | $881.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $166.97 / $248.12 / $390.75
| Professional | 26 | $166.97 | $248.12 | $390.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $205.84 / $280.72 / $507.21
| Professional | TC | $205.84 | $280.72 | $507.21 |