- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.53 / $24.53 / $39.61
| Facility | 26 | $24.53 | $24.53 | $39.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.90 / $235.09 / $366.19
| Professional | | $221.90 | $235.09 | $366.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.60 / $23.73 / $35.78
| Professional | 26 | $20.60 | $23.73 | $35.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $201.28 / $211.37 / $330.38
| Professional | TC | $201.28 | $211.37 | $330.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.39 / $495.85 / $545.46
| Professional | | $412.39 | $495.85 | $545.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.40 / $53.38 / $58.52
| Professional | 26 | $44.40 | $53.38 | $58.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $368.01 / $442.47 / $486.74
| Professional | TC | $368.01 | $442.47 | $486.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.54 / $412.98 / $575.07
| Professional | | $297.54 | $412.98 | $575.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.15 / $43.14 / $57.06
| Professional | 26 | $29.15 | $43.14 | $57.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $268.39 / $369.84 / $517.17
| Professional | TC | $268.39 | $369.84 | $517.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.04 / $480.24 / $1,459.76
| Professional | | $278.04 | $480.24 | $1,459.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.49 / $47.48 / $147.05
| Professional | 26 | $27.49 | $47.48 | $147.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $250.55 / $432.76 / $1,312.71
| Professional | TC | $250.55 | $432.76 | $1,312.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.57 / $454.97 / $620.67
| Professional | | $247.57 | $454.97 | $620.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.17 / $45.23 / $61.18
| Professional | 26 | $27.17 | $45.23 | $61.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.67 / $409.99 / $559.50
| Professional | TC | $233.67 | $409.99 | $559.50 |