- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $101.93 / $101.93 / $137.60
| Facility | 26 | $101.93 | $101.93 | $137.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.04 / $565.45 / $593.72
| Professional | | $387.04 | $565.45 | $593.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.62 / $101.93 / $107.02
| Professional | 26 | $67.62 | $101.93 | $107.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $315.25 / $463.51 / $486.69
| Professional | TC | $315.25 | $463.51 | $486.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.87 / $379.07 / $505.43
| Professional | | $306.87 | $379.07 | $505.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.26 / $72.52 / $91.52
| Professional | 26 | $55.26 | $72.52 | $91.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.51 / $815.01 / $896.51
| Professional | | $570.51 | $815.01 | $896.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.42 / $146.31 / $160.94
| Professional | 26 | $102.42 | $146.31 | $160.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $468.09 / $668.70 / $735.57
| Professional | TC | $468.09 | $668.70 | $735.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.66 / $647.03 / $2,563.94
| Professional | | $471.66 | $647.03 | $2,563.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.34 / $114.42 / $446.40
| Professional | 26 | $80.34 | $114.42 | $446.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $391.31 / $516.07 / $2,117.55
| Professional | TC | $391.31 | $516.07 | $2,117.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.45 / $436.45 / $814.03
| Professional | | $342.45 | $436.45 | $814.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.63 / $77.95 / $147.32
| Professional | 26 | $60.63 | $77.95 | $147.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $282.69 / $363.45 / $667.86
| Professional | TC | $282.69 | $363.45 | $667.86 |