- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.16 / $383.65 / $486.73
| Professional | | $312.16 | $383.65 | $486.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.17 / $73.98 / $84.93
| Professional | 26 | $62.17 | $73.98 | $84.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.33 / $318.11 / $401.80
| Professional | TC | $239.33 | $318.11 | $401.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $424.31 / $424.31 / $424.31
| Facility | 26 | $424.31 | $424.31 | $424.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.07 / $524.64 / $932.29
| Professional | | $445.07 | $524.64 | $932.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.12 / $107.41 / $251.83
| Professional | 26 | $91.12 | $107.41 | $251.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $349.16 / $349.16 / $393.85
| Professional | TC | $349.16 | $349.16 | $393.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.56 / $561.62 / $932.29
| Professional | | $320.56 | $561.62 | $932.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.71 / $99.90 / $251.83
| Professional | 26 | $88.71 | $99.90 | $251.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $231.85 / $315.86 / $810.61
| Professional | TC | $231.85 | $315.86 | $810.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.56 / $559.14 / $932.29
| Professional | | $320.56 | $559.14 | $932.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.71 / $99.90 / $251.83
| Professional | 26 | $88.71 | $99.90 | $251.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $231.85 / $315.86 / $500.63
| Professional | TC | $231.85 | $315.86 | $500.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.54 / $510.73 / $944.85
| Professional | | $251.54 | $510.73 | $944.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.59 / $97.10 / $267.89
| Professional | 26 | $64.59 | $97.10 | $267.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $186.94 / $371.63 / $723.82
| Professional | TC | $186.94 | $371.63 | $723.82 |