- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.49 / $44.07 / $77.27
| Facility | 26 | $35.49 | $44.07 | $77.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.87 / $298.70 / $548.44
| Professional | | $251.87 | $298.70 | $548.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.17 / $41.71 / $105.53
| Professional | 26 | $33.17 | $41.71 | $105.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.71 / $254.08 / $484.13
| Professional | TC | $218.71 | $254.08 | $484.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.76 / $338.40 / $551.03
| Professional | | $277.76 | $338.40 | $551.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.01 / $47.49 / $71.54
| Professional | 26 | $36.01 | $47.49 | $71.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $238.43 / $302.14 / $475.98
| Professional | TC | $238.43 | $302.14 | $475.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.12 / $42.12 / $42.12
| Facility | 26 | $42.12 | $42.12 | $42.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.85 / $400.05 / $704.28
| Professional | | $248.85 | $400.05 | $704.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.52 / $53.28 / $87.80
| Professional | 26 | $37.52 | $53.28 | $87.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $212.46 / $349.72 / $621.79
| Professional | TC | $212.46 | $349.72 | $621.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.94 / $343.57 / $687.11
| Professional | | $231.94 | $343.57 | $687.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.75 / $43.67 / $77.94
| Professional | 26 | $33.75 | $43.67 | $77.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $196.32 / $303.87 / $596.50
| Professional | TC | $196.32 | $303.87 | $596.50 |