- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $467.74 / $1,000.00
| Facility | | $100.00 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $60.26 / $165.96
| Facility | 26 | $33.88 | $60.26 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $128.82 / $467.74
| Professional | | $79.43 | $128.82 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $131.83 / $645.65
| Professional | 26 | $35.48 | $131.83 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.12 / $74.13 / $275.42
| Professional | TC | $50.12 | $74.13 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $109.65 / $281.84
| Professional | | $54.95 | $109.65 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $43.65 / $114.82
| Professional | 26 | $20.42 | $43.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.48 / $50.12 / $169.82
| Professional | TC | $35.48 | $50.12 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $208.93 / $912.01
| Facility | | $66.07 | $208.93 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $72.44 / $109.65
| Facility | 26 | $13.49 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $112.20 / $234.42
| Professional | | $54.95 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $41.69 / $95.50
| Professional | 26 | $19.95 | $41.69 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.36 / $61.66 / $147.91
| Professional | TC | $32.36 | $61.66 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $61.66 / $114.82
| Facility | | $28.18 | $61.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $117.49 / $257.04
| Professional | | $69.18 | $117.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $43.65 / $93.33
| Professional | 26 | $25.70 | $43.65 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $69.18 / $158.49
| Professional | TC | $39.81 | $69.18 | $158.49 |