- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.89 / $35.04 / $76.97
| Facility | 26 | $31.89 | $35.04 | $76.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.87 / $268.23 / $588.99
| Professional | | $251.87 | $268.23 | $588.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.17 / $38.67 / $76.97
| Professional | 26 | $33.17 | $38.67 | $76.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.71 / $234.16 / $512.03
| Professional | TC | $218.71 | $234.16 | $512.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.98 / $84.98 / $84.98
| Professional | 26 | $84.98 | $84.98 | $84.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.00 / $401.00 / $401.00
| Professional | | $401.00 | $401.00 | $401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.33 / $402.58 / $713.37
| Professional | | $264.33 | $402.58 | $713.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.47 / $60.96 / $87.80
| Professional | 26 | $37.47 | $60.96 | $87.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $267.36 / $349.34 / $622.83
| Professional | TC | $267.36 | $349.34 | $622.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.74 / $335.99 / $743.10
| Professional | | $212.74 | $335.99 | $743.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.29 / $42.48 / $87.00
| Professional | 26 | $31.29 | $42.48 | $87.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $166.46 / $286.48 / $425.42
| Professional | TC | $166.46 | $286.48 | $425.42 |