- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.72 / $58.72 / $58.72
| Facility | 26 | $58.72 | $58.72 | $58.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.25 / $377.25 / $531.91
| Professional | | $377.25 | $377.25 | $531.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.02 / $58.72 / $115.32
| Professional | 26 | $47.02 | $58.72 | $115.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $318.52 / $318.52 / $449.12
| Professional | TC | $318.52 | $318.52 | $449.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.40 / $411.63 / $628.92
| Professional | | $335.40 | $411.63 | $628.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.55 / $70.06 / $93.35
| Professional | 26 | $58.55 | $70.06 | $93.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $276.86 / $339.78 / $535.58
| Professional | TC | $276.86 | $339.78 | $535.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.99 / $257.34 / $353.09
| Professional | | $32.99 | $257.34 | $353.09 |
- 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
- $516.54 / $661.75 / $703.43
| Professional | | $516.54 | $661.75 | $703.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.37 / $104.86 / $111.46
| Professional | 26 | $73.37 | $104.86 | $111.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $443.18 / $556.89 / $591.97
| Professional | TC | $443.18 | $556.89 | $591.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.62 / $401.32 / $667.21
| Professional | | $298.62 | $401.32 | $667.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.06 / $53.77 / $89.40
| Professional | 26 | $45.06 | $53.77 | $89.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $253.56 / $330.17 / $577.80
| Professional | TC | $253.56 | $330.17 | $577.80 |