- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.01 / $26.01 / $55.09
| Facility | 26 | $26.01 | $26.01 | $55.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.52 / $318.62 / $911.11
| Professional | | $300.52 | $318.62 | $911.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.39 / $44.07 / $189.00
| Professional | 26 | $30.39 | $44.07 | $189.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $270.12 / $312.10 / $827.50
| Professional | TC | $270.12 | $312.10 | $827.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.64 / $200.57 / $359.55
| Professional | | $32.64 | $200.57 | $359.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.26 / $436.91 / $580.89
| Professional | | $383.26 | $436.91 | $580.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $48.47 / $65.80
| Professional | 26 | $39.81 | $48.47 | $65.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $343.94 / $388.45 / $515.10
| Professional | TC | $343.94 | $388.45 | $515.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $53.46 / $421.21
| Professional | | $32.34 | $53.46 | $421.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.26 / $483.73 / $580.89
| Professional | | $383.26 | $483.73 | $580.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $53.66 / $65.80
| Professional | 26 | $39.81 | $53.66 | $65.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $343.94 / $430.07 / $515.10
| Professional | TC | $343.94 | $430.07 | $515.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.74 / $295.83 / $660.11
| Professional | | $287.74 | $295.83 | $660.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.23 / $32.96 / $72.48
| Professional | 26 | $31.23 | $32.96 | $72.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $256.08 / $275.83 / $587.63
| Professional | TC | $256.08 | $275.83 | $587.63 |