- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $154.88 / $371.54
| Facility | 26 | $69.18 | $154.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $151.36 / $588.84
| Professional | | $95.50 | $151.36 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.11 / $56.23 / $251.19
| Professional | TC | $33.11 | $56.23 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $229.09 / $588.84
| Facility | 26 | $102.33 | $229.09 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $1,148.15
| Professional | | $117.49 | $204.17 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.67 / $83.18 / $602.56
| Professional | TC | $44.67 | $83.18 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $446.68
| Professional | | $186.21 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.44 / $104.71 / $173.78
| Professional | TC | $72.44 | $104.71 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $138.04 / $251.19
| Professional | | $75.86 | $138.04 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $407.38
| Professional | | $147.91 | $234.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.95 / $74.13 / $141.25
| Professional | TC | $54.95 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $134.90
| Professional | | $128.82 | $128.82 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $229.09 / $588.84
| Facility | 26 | $102.33 | $229.09 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $1,148.15
| Professional | | $117.49 | $204.17 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.67 / $83.18 / $602.56
| Professional | TC | $44.67 | $83.18 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $239.88 / $467.74
| Professional | | $162.18 | $239.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.23 / $102.33 / $165.96
| Professional | TC | $56.23 | $102.33 | $165.96 |