- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.20 / $60.20 / $60.20
| Facility | 26 | $60.20 | $60.20 | $60.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.23 / $363.92 / $420.62
| Professional | | $341.23 | $363.92 | $420.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.19 / $57.27 / $60.20
| Professional | 26 | $55.19 | $57.27 | $60.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $286.04 / $303.73 / $364.72
| Professional | TC | $286.04 | $303.73 | $364.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.27 / $553.16 / $1,639.62
| Professional | | $469.27 | $553.16 | $1,639.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.97 / $102.51 / $202.53
| Professional | 26 | $86.97 | $102.51 | $202.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $407.16 / $407.16 / $483.64
| Professional | TC | $407.16 | $407.16 | $483.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.94 / $562.91 / $1,639.62
| Professional | | $258.94 | $562.91 | $1,639.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.21 / $79.61 / $202.53
| Professional | 26 | $43.21 | $79.61 | $202.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $198.73 / $483.77 / $856.19
| Professional | TC | $198.73 | $483.77 | $856.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.28 / $568.42 / $987.58
| Professional | | $202.28 | $568.42 | $987.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.53 / $80.06 / $131.38
| Professional | 26 | $68.53 | $80.06 | $131.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $198.73 / $487.80 / $796.28
| Professional | TC | $198.73 | $487.80 | $796.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.26 / $570.02 / $1,803.21
| Professional | | $249.26 | $570.02 | $1,803.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.69 / $82.52 / $239.88
| Professional | 26 | $74.69 | $82.52 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $174.57 / $537.76 / $1,563.33
| Professional | TC | $174.57 | $537.76 | $1,563.33 |