- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.18 / $43.78 / $66.06
| Facility | 26 | $34.18 | $43.78 | $66.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.27 / $365.19 / $417.35
| Professional | | $278.27 | $365.19 | $417.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.32 / $39.83 / $42.58
| Professional | 26 | $28.32 | $39.83 | $42.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $249.95 / $324.76 / $374.77
| Professional | TC | $249.95 | $324.76 | $374.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.28 / $31.28 / $39.10
| Professional | 26 | $31.28 | $31.28 | $39.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.52 / $403.20 / $553.65
| Professional | | $52.52 | $403.20 | $553.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.56 / $396.72 / $602.90
| Professional | | $341.56 | $396.72 | $602.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.53 / $42.07 / $62.58
| Professional | 26 | $37.53 | $42.07 | $62.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $308.23 / $348.59 / $540.32
| Professional | TC | $308.23 | $348.59 | $540.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.49 / $189.21 / $189.21
| Facility | 26 | $99.49 | $189.21 | $189.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.97 / $457.26 / $897.60
| Professional | | $374.97 | $457.26 | $897.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.67 / $44.34 / $103.10
| Professional | 26 | $36.67 | $44.34 | $103.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $329.14 / $407.83 / $902.33
| Professional | TC | $329.14 | $407.83 | $902.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.81 / $452.17 / $839.30
| Professional | | $365.81 | $452.17 | $839.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.67 / $44.34 / $89.96
| Professional | 26 | $36.67 | $44.34 | $89.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $329.14 / $390.86 / $617.14
| Professional | TC | $329.14 | $390.86 | $617.14 |