- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.47 / $46.47 / $165.36
| Facility | 26 | $46.47 | $46.47 | $165.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.74 / $464.74 / $655.28
| Professional | | $464.74 | $464.74 | $655.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.86 / $71.01 / $108.19
| Professional | 26 | $39.86 | $71.01 | $108.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $418.27 / $418.27 / $589.76
| Professional | TC | $418.27 | $418.27 | $589.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.04 / $606.92 / $918.31
| Professional | | $479.04 | $606.92 | $918.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.13 / $59.07 / $90.91
| Professional | 26 | $48.13 | $59.07 | $90.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $430.91 / $547.95 / $836.44
| Professional | TC | $430.91 | $547.95 | $836.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.60 / $299.85 / $407.79
| Professional | | $32.60 | $299.85 | $407.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $890.71 / $890.71 / $890.71
| Facility | 26 | $890.71 | $890.71 | $890.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.89 / $868.84 / $923.56
| Professional | | $591.89 | $868.84 | $923.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.47 / $89.07 / $94.68
| Professional | 26 | $61.47 | $89.07 | $94.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $530.41 / $779.75 / $828.86
| Professional | TC | $530.41 | $779.75 | $828.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.51 / $457.26 / $760.21
| Professional | | $381.51 | $457.26 | $760.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.81 / $44.32 / $76.20
| Professional | 26 | $35.81 | $44.32 | $76.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $345.70 / $427.40 / $684.01
| Professional | TC | $345.70 | $427.40 | $684.01 |