- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $89.13 / $93.33
| Facility | 26 | $63.10 | $89.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $234.42 / $371.54
| Professional | | $169.82 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $72.44 / $173.78
| Professional | 26 | $52.48 | $72.44 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.82 / $173.78 / $275.42
| Professional | TC | $114.82 | $173.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $77.62 / $104.71
| Professional | 26 | $43.65 | $77.62 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $251.19 / $323.59
| Professional | | $218.78 | $251.19 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $72.44 / $93.33
| Professional | 26 | $63.10 | $72.44 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $154.88 / $177.83 / $229.09
| Professional | TC | $154.88 | $177.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $346.74 / $537.03
| Professional | | $173.78 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $83.18 / $138.04
| Professional | 26 | $56.23 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.82 / $245.47 / $398.11
| Professional | TC | $128.82 | $245.47 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $107.15 / $134.90
| Professional | 26 | $36.31 | $107.15 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $489.78
| Professional | | $173.78 | $295.12 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $67.61 / $112.20
| Professional | 26 | $53.70 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $120.23 / $186.21 / $354.81
| Professional | TC | $120.23 | $186.21 | $354.81 |