- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.72 / $285.94 / $307.99
| Professional | | $232.72 | $285.94 | $307.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.57 / $56.89 / $66.34
| Professional | 26 | $48.57 | $56.89 | $66.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $184.15 / $229.28 / $241.66
| Professional | TC | $184.15 | $229.28 | $241.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $330.93 / $330.93 / $330.93
| Facility | 26 | $330.93 | $330.93 | $330.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.27 / $651.94 / $1,599.00
| Professional | | $326.27 | $651.94 | $1,599.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.91 / $83.59 / $225.27
| Professional | 26 | $70.91 | $83.59 | $225.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.03 / $253.15 / $253.15
| Professional | TC | $245.03 | $253.15 | $253.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.98 / $369.41 / $651.94
| Professional | | $215.98 | $369.41 | $651.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.65 / $79.33 / $225.27
| Professional | 26 | $70.65 | $79.33 | $225.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $142.31 / $147.44 / $434.60
| Professional | TC | $142.31 | $147.44 | $434.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.98 / $364.80 / $651.94
| Professional | | $215.98 | $364.80 | $651.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.67 / $79.33 / $225.27
| Professional | 26 | $73.67 | $79.33 | $225.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $142.31 / $147.44 / $304.33
| Professional | TC | $142.31 | $147.44 | $304.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.22 / $356.06 / $621.49
| Professional | | $182.22 | $356.06 | $621.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.84 / $79.95 / $239.63
| Professional | 26 | $54.84 | $79.95 | $239.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $107.91 / $233.03 / $453.87
| Professional | TC | $107.91 | $233.03 | $453.87 |