- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $56.73 / $99.59
| Facility | 26 | $45.71 | $56.73 | $99.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.32 / $313.58 / $567.41
| Professional | | $267.32 | $313.58 | $567.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.74 / $50.69 / $110.46
| Professional | 26 | $42.74 | $50.69 | $110.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.84 / $261.19 / $495.22
| Professional | TC | $223.84 | $261.19 | $495.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.82 / $368.81 / $583.36
| Professional | | $288.82 | $368.81 | $583.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.46 / $60.88 / $93.23
| Professional | 26 | $46.46 | $60.88 | $93.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $242.84 / $312.19 / $493.82
| Professional | TC | $242.84 | $312.19 | $493.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.48 / $54.48 / $54.48
| Facility | 26 | $54.48 | $54.48 | $54.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.64 / $454.08 / $758.97
| Professional | | $281.64 | $454.08 | $758.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.38 / $69.48 / $112.92
| Professional | 26 | $49.38 | $69.48 | $112.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.20 / $385.56 / $661.42
| Professional | TC | $239.20 | $385.56 | $661.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.08 / $371.27 / $695.61
| Professional | | $273.08 | $371.27 | $695.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.67 / $56.78 / $102.70
| Professional | 26 | $43.67 | $56.78 | $102.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.48 / $329.82 / $581.48
| Professional | TC | $233.48 | $329.82 | $581.48 |