- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $95.50 / $229.09
| Facility | 26 | $44.67 | $95.50 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $1,096.48
| Professional | | $169.82 | $281.84 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $97.72 / $229.09
| Professional | 26 | $53.70 | $97.72 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.82 / $186.21 / $446.68
| Professional | TC | $114.82 | $186.21 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $134.90 / $524.81 / $524.81
| Facility | 26 | $134.90 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $316.23 / $1,949.84
| Professional | | $162.18 | $316.23 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $81.28 / $436.52
| Professional | 26 | $50.12 | $81.28 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.03 / $245.47 / $1,905.46
| Professional | TC | $123.03 | $245.47 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $467.74 / $776.25
| Professional | | $269.15 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $112.20 / $147.91
| Professional | 26 | $66.07 | $112.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $380.19 / $616.60
| Professional | | $169.82 | $380.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $83.18 / $169.82
| Professional | 26 | $48.98 | $83.18 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $125.89 / $281.84 / $467.74
| Professional | TC | $125.89 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $181.97 / $389.05
| Professional | | $75.86 | $181.97 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $275.42 / $524.81
| Professional | | $173.78 | $275.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $85.11 / $158.49
| Professional | 26 | $57.54 | $85.11 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.90 / $194.98 / $338.84
| Professional | TC | $134.90 | $194.98 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $93.33 / $114.82
| Professional | | $81.28 | $93.33 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $134.90 / $524.81 / $524.81
| Facility | 26 | $134.90 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $316.23 / $1,949.84
| Professional | | $162.18 | $316.23 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $81.28 / $436.52
| Professional | 26 | $51.29 | $81.28 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $120.23 / $245.47 / $1,905.46
| Professional | TC | $120.23 | $245.47 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $275.42 / $281.84
| Professional | | $158.49 | $275.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $316.23 / $549.54
| Professional | | $199.53 | $316.23 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $81.28 / $169.82
| Professional | 26 | $56.23 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $134.90 / $218.78 / $426.58
| Professional | TC | $134.90 | $218.78 | $426.58 |