- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $38.02 / $66.07
| Facility | 26 | $38.02 | $38.02 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $446.68
| Professional | | $190.55 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $66.07 / $131.83
| Professional | 26 | $33.11 | $66.07 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $158.49 / $245.47 / $363.08
| Professional | TC | $158.49 | $245.47 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $676.08
| Professional | | $467.74 | $549.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $77.62 / $95.50
| Professional | 26 | $66.07 | $77.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $398.11 / $478.63 / $588.84
| Professional | TC | $398.11 | $478.63 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $416.87 / $645.65
| Professional | | $281.84 | $416.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $63.10 / $89.13
| Professional | 26 | $44.67 | $63.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $229.09 / $354.81 / $562.34
| Professional | TC | $229.09 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $501.19 / $2,398.83
| Professional | | $257.04 | $501.19 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $72.44 / $724.44
| Professional | 26 | $38.90 | $72.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.78 / $457.09 / $1,659.59
| Professional | TC | $218.78 | $457.09 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $501.19 / $724.44
| Professional | | $234.42 | $501.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $69.18 / $97.72
| Professional | 26 | $36.31 | $69.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $436.52 / $616.60
| Professional | TC | $190.55 | $436.52 | $616.60 |