- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $53.70 / $151.36
| Facility | 26 | $36.31 | $53.70 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $281.84 / $602.56
| Professional | | $229.09 | $281.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $40.74 / $87.10
| Professional | 26 | $33.88 | $40.74 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $234.42 / $389.05
| Professional | TC | $190.55 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $512.86
| Professional | | $190.55 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $41.69 / $75.86
| Professional | 26 | $30.20 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $173.78 / $251.19 / $446.68
| Professional | TC | $173.78 | $251.19 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $48.98 / $109.65
| Facility | 26 | $9.33 | $48.98 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $707.95
| Professional | | $234.42 | $354.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $52.48 / $102.33
| Professional | 26 | $37.15 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $204.17 / $302.00 / $602.56
| Professional | TC | $204.17 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $309.03 / $549.54
| Professional | | $223.87 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $44.67 / $81.28
| Professional | 26 | $33.11 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $263.03 / $467.74
| Professional | TC | $190.55 | $263.03 | $467.74 |