- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.98 / $58.98 / $94.66
| Facility | 26 | $58.98 | $58.98 | $94.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.02 / $344.63 / $363.37
| Professional | | $330.02 | $344.63 | $363.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.03 / $55.45 / $58.98
| Professional | 26 | $49.03 | $55.45 | $58.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $280.99 / $287.83 / $304.39
| Professional | TC | $280.99 | $287.83 | $304.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.04 / $728.69 / $801.60
| Professional | | $606.04 | $728.69 | $801.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.16 / $127.64 / $139.94
| Professional | 26 | $106.16 | $127.64 | $139.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $499.89 / $601.04 / $661.19
| Professional | TC | $499.89 | $601.04 | $661.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.41 / $606.46 / $848.06
| Professional | | $434.41 | $606.46 | $848.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.66 / $103.40 / $136.72
| Professional | 26 | $69.66 | $103.40 | $136.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $364.75 / $503.06 / $703.47
| Professional | TC | $364.75 | $503.06 | $703.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.75 / $701.17 / $2,141.04
| Professional | | $410.75 | $701.17 | $2,141.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.86 / $112.02 / $351.55
| Professional | 26 | $64.86 | $112.02 | $351.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $345.89 / $597.46 / $1,789.49
| Professional | TC | $345.89 | $597.46 | $1,789.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.87 / $671.46 / $915.36
| Professional | | $383.87 | $671.46 | $915.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.86 / $107.68 / $147.09
| Professional | 26 | $64.86 | $107.68 | $147.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $317.95 / $566.01 / $768.27
| Professional | TC | $317.95 | $566.01 | $768.27 |