- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.07 / $65.05 / $316.39
| Facility | 26 | $56.07 | $65.05 | $316.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.00 / $243.47 / $350.87
| Professional | | $171.00 | $243.47 | $350.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.30 / $60.72 / $77.81
| Professional | 26 | $51.30 | $60.72 | $77.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.70 / $173.79 / $281.89
| Professional | TC | $119.70 | $173.79 | $281.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.41 / $90.41 / $90.41
| Professional | 26 | $90.41 | $90.41 | $90.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.40 / $194.95 / $267.69
| Professional | | $57.40 | $194.95 | $267.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.27 / $56.27 / $89.86
| Facility | 26 | $56.27 | $56.27 | $89.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.31 / $305.20 / $465.84
| Professional | | $168.31 | $305.20 | $465.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.24 / $56.98 / $95.96
| Professional | 26 | $50.24 | $56.98 | $95.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $117.26 / $246.62 / $383.42
| Professional | TC | $117.26 | $246.62 | $383.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $414.72 / $537.20 / $537.20
| Facility | 26 | $414.72 | $537.20 | $537.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.97 / $302.61 / $2,082.64
| Professional | | $205.97 | $302.61 | $2,082.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.61 / $65.56 / $381.41
| Professional | 26 | $49.61 | $65.56 | $381.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.97 / $257.18 / $1,754.89
| Professional | TC | $151.97 | $257.18 | $1,754.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.97 / $272.26 / $454.32
| Professional | | $205.97 | $272.26 | $454.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.61 / $62.07 / $98.46
| Professional | 26 | $49.61 | $62.07 | $98.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.97 / $192.15 / $343.25
| Professional | TC | $151.97 | $192.15 | $343.25 |