- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.02 / $380.00 / $684.00
| Facility | | $59.02 | $380.00 | $684.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.96 / $28.96 / $29.46
| Facility | 26 | $28.96 | $28.96 | $29.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.57 / $72.59 / $228.41
| Professional | | $44.57 | $72.59 | $228.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $40.78 / $195.39
| Professional | 26 | $25.70 | $40.78 | $195.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.22 / $33.42 / $196.15
| Professional | TC | $20.22 | $33.42 | $196.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.00 / $244.00 / $244.00
| Professional | | $149.00 | $244.00 | $244.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.00 / $126.00 / $126.00
| Professional | 26 | $77.00 | $126.00 | $126.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.00 / $118.00 / $118.00
| Professional | TC | $72.00 | $118.00 | $118.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.64 / $119.29 / $214.11
| Professional | | $78.64 | $119.29 | $214.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.40 / $46.98 / $88.85
| Professional | 26 | $32.40 | $46.98 | $88.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.43 / $53.14 / $168.11
| Professional | TC | $35.43 | $53.14 | $168.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.21 / $157.10 / $641.29
| Professional | | $97.21 | $157.10 | $641.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.02 / $62.69 / $122.20
| Professional | 26 | $33.02 | $62.69 | $122.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.21 / $61.11 / $531.70
| Professional | TC | $43.21 | $61.11 | $531.70 |