- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.44 / $860.39 / $2,165.73
| Facility | | $90.44 | $860.39 | $2,165.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.67 / $36.67 / $37.36
| Facility | 26 | $36.67 | $36.67 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.74 / $146.10 / $153.12
| Professional | | $89.74 | $146.10 | $153.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.49 / $43.29 / $188.96
| Professional | 26 | $32.49 | $43.29 | $188.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.99 / $95.04 / $114.58
| Professional | TC | $58.99 | $95.04 | $114.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.00 / $492.00 / $492.00
| Professional | | $299.00 | $492.00 | $492.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.00 / $160.00 / $160.00
| Professional | 26 | $97.00 | $160.00 | $160.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $202.00 / $332.00 / $332.00
| Professional | TC | $202.00 | $332.00 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.44 / $185.04 / $367.16
| Professional | | $116.44 | $185.04 | $367.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.97 / $59.63 / $106.26
| Professional | 26 | $38.97 | $59.63 | $106.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $77.45 / $125.42 / $232.48
| Professional | TC | $77.45 | $125.42 | $232.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.34 / $241.69 / $477.09
| Professional | | $141.34 | $241.69 | $477.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.47 / $80.79 / $146.91
| Professional | 26 | $39.47 | $80.79 | $146.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $101.25 / $160.90 / $330.17
| Professional | TC | $101.25 | $160.90 | $330.17 |