- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.38 / $35.38 / $36.02
| Facility | 26 | $35.38 | $35.38 | $36.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.77 / $286.77 / $323.42
| Professional | | $286.77 | $286.77 | $323.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.57 / $58.57 / $58.57
| Professional | 26 | $58.57 | $58.57 | $58.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.40 / $251.40 / $285.57
| Professional | TC | $251.40 | $251.40 | $285.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.00 / $787.00 / $1,293.00
| Professional | | $787.00 | $787.00 | $1,293.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $94.00 / $94.00 / $154.00
| Professional | 26 | $94.00 | $94.00 | $154.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $693.00 / $693.00 / $1,139.00
| Professional | TC | $693.00 | $693.00 | $1,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.15 / $391.15 / $801.67
| Professional | | $391.15 | $391.15 | $801.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.47 / $52.47 / $102.59
| Professional | 26 | $52.47 | $52.47 | $102.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $338.69 / $338.69 / $699.07
| Professional | TC | $338.69 | $338.69 | $699.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.84 / $590.24 / $946.38
| Professional | | $250.84 | $590.24 | $946.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.70 / $75.66 / $119.90
| Professional | 26 | $32.70 | $75.66 | $119.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $218.14 / $586.47 / $911.61
| Professional | TC | $218.14 | $586.47 | $911.61 |