- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.02 / $73.02 / $73.02
| Facility | 26 | $73.02 | $73.02 | $73.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.89 / $366.89 / $517.30
| Professional | | $366.89 | $366.89 | $517.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.69 / $73.02 / $73.02
| Professional | 26 | $62.69 | $73.02 | $73.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $293.87 / $293.87 / $414.35
| Professional | TC | $293.87 | $293.87 | $414.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.70 / $389.92 / $631.85
| Professional | | $317.70 | $389.92 | $631.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.48 / $87.74 / $121.08
| Professional | 26 | $71.48 | $87.74 | $121.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $246.22 / $303.35 / $510.77
| Professional | TC | $246.22 | $303.35 | $510.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.99 / $215.55 / $305.09
| Professional | | $32.99 | $215.55 | $305.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,376.81 / $2,376.81 / $2,376.81
| Facility | 26 | $2,376.81 | $2,376.81 | $2,376.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.48 / $664.03 / $705.85
| Professional | | $465.48 | $664.03 | $705.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.69 / $134.27 / $142.72
| Professional | 26 | $93.69 | $134.27 | $142.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $371.79 / $529.76 / $563.12
| Professional | TC | $371.79 | $529.76 | $563.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.95 / $330.16 / $577.79
| Professional | | $289.95 | $330.16 | $577.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.02 / $68.62 / $118.25
| Professional | 26 | $56.02 | $68.62 | $118.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.93 / $299.58 / $463.80
| Professional | TC | $233.93 | $299.58 | $463.80 |