- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $516.98 / $516.98 / $516.98
| Facility | 26 | $516.98 | $516.98 | $516.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.36 / $314.39 / $1,117.00
| Professional | | $252.36 | $314.39 | $1,117.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.29 / $97.12 / $379.00
| Professional | 26 | $81.29 | $97.12 | $379.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $165.09 / $194.26 / $207.55
| Professional | TC | $165.09 | $194.26 | $207.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.48 / $275.86 / $498.47
| Professional | | $234.48 | $275.86 | $498.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.40 / $96.28 / $150.28
| Professional | 26 | $67.40 | $96.28 | $150.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $125.71 / $179.58 / $179.58
| Professional | TC | $125.71 | $179.58 | $179.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.47 / $436.67 / $526.71
| Professional | | $231.47 | $436.67 | $526.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.63 / $150.02 / $175.92
| Professional | 26 | $85.63 | $150.02 | $175.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $187.06 / $286.10 / $332.05
| Professional | TC | $187.06 | $286.10 | $332.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.27 / $316.52 / $499.13
| Professional | | $239.27 | $316.52 | $499.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.98 / $120.39 / $175.93
| Professional | 26 | $84.98 | $120.39 | $175.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $147.34 / $196.01 / $294.02
| Professional | TC | $147.34 | $196.01 | $294.02 |