- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.29 / $71.29 / $71.29
| Facility | 26 | $71.29 | $71.29 | $71.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.62 / $330.64 / $435.20
| Professional | | $189.62 | $330.64 | $435.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.76 / $56.73 / $71.29
| Professional | 26 | $47.76 | $56.73 | $71.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $133.25 / $273.91 / $370.94
| Professional | TC | $133.25 | $273.91 | $370.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.84 / $69.84 / $77.38
| Professional | 26 | $69.84 | $69.84 | $77.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.50 / $407.50 / $480.85
| Professional | | $407.50 | $407.50 | $480.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.17 / $70.17 / $82.80
| Professional | 26 | $70.17 | $70.17 | $82.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $337.33 / $337.33 / $398.05
| Professional | TC | $337.33 | $337.33 | $398.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.47 / $174.39 / $437.54
| Professional | | $97.47 | $174.39 | $437.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.67 / $32.08 / $107.98
| Professional | 26 | $29.67 | $32.08 | $107.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.68 / $144.10 / $369.38
| Professional | TC | $65.68 | $144.10 | $369.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.86 / $228.78 / $411.78
| Professional | | $169.86 | $228.78 | $411.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.28 / $53.42 / $71.69
| Professional | 26 | $39.28 | $53.42 | $71.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $113.07 / $206.57 / $344.29
| Professional | TC | $113.07 | $206.57 | $344.29 |