- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.43 / $64.15 / $64.15
| Facility | 26 | $34.43 | $64.15 | $64.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.22 / $257.67 / $451.97
| Professional | | $171.22 | $257.67 | $451.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.35 / $35.95 / $67.34
| Professional | 26 | $30.35 | $35.95 | $67.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $140.87 / $221.72 / $384.60
| Professional | TC | $140.87 | $221.72 | $384.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.79 / $203.93 / $208.67
| Professional | | $182.79 | $203.93 | $208.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.28 / $41.29 / $45.63
| Professional | 26 | $29.28 | $41.29 | $45.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.38 / $386.82 / $456.45
| Professional | | $282.38 | $386.82 | $456.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.04 / $53.49 / $63.12
| Professional | 26 | $39.04 | $53.49 | $63.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $243.33 / $333.33 / $393.33
| Professional | TC | $243.33 | $333.33 | $393.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.68 / $38.68 / $38.68
| Facility | 26 | $38.68 | $38.68 | $38.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.23 / $289.48 / $843.18
| Professional | | $227.23 | $289.48 | $843.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.47 / $46.06 / $119.19
| Professional | 26 | $35.47 | $46.06 | $119.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $183.93 / $260.43 / $723.99
| Professional | TC | $183.93 | $260.43 | $723.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.48 / $241.43 / $320.13
| Professional | | $178.48 | $241.43 | $320.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.19 / $36.94 / $46.31
| Professional | 26 | $28.19 | $36.94 | $46.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $147.77 / $203.08 / $269.14
| Professional | TC | $147.77 | $203.08 | $269.14 |