- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.38 / $88.38 / $88.38
| Facility | 26 | $88.38 | $88.38 | $88.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.49 / $403.00 / $566.82
| Professional | | $332.49 | $403.00 | $566.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.23 / $88.38 / $191.70
| Professional | 26 | $65.23 | $88.38 | $191.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $267.24 / $315.54 / $447.51
| Professional | TC | $267.24 | $315.54 | $447.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.36 / $1,028.06 / $1,127.15
| Professional | | $845.36 | $1,028.06 | $1,127.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $159.66 / $194.17 / $212.88
| Professional | 26 | $159.66 | $194.17 | $212.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $685.70 / $833.90 / $914.27
| Professional | TC | $685.70 | $833.90 | $914.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.04 / $956.51 / $1,494.71
| Professional | | $342.04 | $956.51 | $1,494.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.54 / $186.28 / $275.49
| Professional | 26 | $99.54 | $186.28 | $275.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $268.66 / $780.22 / $1,219.23
| Professional | TC | $268.66 | $780.22 | $1,219.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.83 / $760.25 / $2,747.80
| Professional | | $416.83 | $760.25 | $2,747.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.86 / $164.38 / $774.69
| Professional | 26 | $89.86 | $164.38 | $774.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $326.97 / $598.12 / $2,208.88
| Professional | TC | $326.97 | $598.12 | $2,208.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.83 / $782.52 / $992.43
| Professional | | $416.83 | $782.52 | $992.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.86 / $158.47 / $209.71
| Professional | 26 | $89.86 | $158.47 | $209.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $326.97 / $592.09 / $782.72
| Professional | TC | $326.97 | $592.09 | $782.72 |