- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.90 / $44.90 / $71.66
| Facility | 26 | $44.90 | $44.90 | $71.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.83 / $436.79 / $667.57
| Professional | | $411.83 | $436.79 | $667.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.71 / $41.51 / $97.20
| Professional | 26 | $36.71 | $41.51 | $97.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $375.12 / $399.06 / $602.77
| Professional | TC | $375.12 | $399.06 | $602.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.45 / $903.52 / $993.91
| Professional | | $751.45 | $903.52 | $993.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.42 / $96.70 / $106.02
| Professional | 26 | $80.42 | $96.70 | $106.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $671.03 / $806.83 / $887.55
| Professional | TC | $671.03 | $806.83 | $887.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.35 / $753.64 / $1,053.86
| Professional | | $542.35 | $753.64 | $1,053.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.80 / $78.03 / $105.75
| Professional | 26 | $52.80 | $78.03 | $105.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $489.54 / $675.61 / $944.76
| Professional | TC | $489.54 | $675.61 | $944.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.54 / $892.22 / $2,679.53
| Professional | | $516.54 | $892.22 | $2,679.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.25 / $85.06 / $266.22
| Professional | 26 | $49.25 | $85.06 | $266.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $467.30 / $807.16 / $2,413.31
| Professional | TC | $467.30 | $807.16 | $2,413.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.94 / $845.26 / $1,147.54
| Professional | | $476.94 | $845.26 | $1,147.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.25 / $82.68 / $111.85
| Professional | 26 | $49.25 | $82.68 | $111.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $427.40 / $797.70 / $1,035.69
| Professional | TC | $427.40 | $797.70 | $1,035.69 |