- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.61 / $36.61 / $58.84
| Facility | 26 | $36.61 | $36.61 | $58.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.52 / $320.17 / $496.60
| Professional | | $300.52 | $320.17 | $496.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.39 / $34.39 / $79.20
| Professional | 26 | $30.39 | $34.39 | $79.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $270.12 / $287.36 / $443.37
| Professional | TC | $270.12 | $287.36 | $443.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.73 / $673.00 / $740.33
| Professional | | $559.73 | $673.00 | $740.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.27 / $79.67 / $87.35
| Professional | 26 | $66.27 | $79.67 | $87.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $493.46 / $593.32 / $652.67
| Professional | TC | $493.46 | $593.32 | $652.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.48 / $560.79 / $807.32
| Professional | | $403.48 | $560.79 | $807.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.43 / $64.06 / $87.27
| Professional | 26 | $43.43 | $64.06 | $87.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $360.05 / $496.72 / $720.05
| Professional | TC | $360.05 | $496.72 | $720.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.71 / $657.59 / $1,991.14
| Professional | | $380.71 | $657.59 | $1,991.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.34 / $69.67 / $218.97
| Professional | 26 | $40.34 | $69.67 | $218.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $340.37 / $587.91 / $1,772.11
| Professional | TC | $340.37 | $587.91 | $1,772.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.51 / $622.98 / $849.56
| Professional | | $355.51 | $622.98 | $849.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.34 / $66.76 / $91.33
| Professional | 26 | $40.34 | $66.76 | $91.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $314.36 / $581.03 / $758.23
| Professional | TC | $314.36 | $581.03 | $758.23 |