- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.19 / $594.17 / $4,904.14
| Facility | | $231.19 | $594.17 | $4,904.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.18 / $201.89 / $432.22
| Facility | 26 | $68.18 | $201.89 | $432.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.20 / $254.66 / $819.46
| Professional | | $212.20 | $254.66 | $819.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.81 / $72.09 / $201.89
| Professional | 26 | $64.81 | $72.09 | $201.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $126.43 / $183.15 / $206.58
| Professional | TC | $126.43 | $183.15 | $206.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.00 / $293.91 / $395.13
| Professional | | $170.00 | $293.91 | $395.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.56 / $85.29 / $125.63
| Professional | 26 | $65.56 | $85.29 | $125.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.42 / $214.63 / $276.85
| Professional | TC | $123.42 | $214.63 | $276.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.52 / $1,314.08 / $2,728.11
| Facility | | $782.52 | $1,314.08 | $2,728.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.89 / $185.89 / $185.89
| Professional | | $185.89 | $185.89 | $185.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.86 / $62.86 / $64.63
| Professional | 26 | $62.86 | $62.86 | $64.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.50 / $297.66 / $523.60
| Professional | | $196.50 | $297.66 | $523.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.73 / $82.84 / $166.83
| Professional | 26 | $58.73 | $82.84 | $166.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $136.41 / $245.06 / $339.03
| Professional | TC | $136.41 | $245.06 | $339.03 |