- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.43 / $430.29 / $461.81
| Professional | | $349.43 | $430.29 | $461.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.97 / $71.18 / $83.30
| Professional | 26 | $60.97 | $71.18 | $83.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.44 / $359.11 / $378.51
| Professional | TC | $288.44 | $359.11 | $378.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.80 / $816.50 / $1,599.00
| Professional | | $420.80 | $816.50 | $1,599.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.85 / $461.41 / $816.50
| Professional | | $270.85 | $461.41 | $816.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.46 / $91.21 / $253.27
| Professional | 26 | $82.46 | $91.21 | $253.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.38 / $194.86 / $579.66
| Professional | TC | $188.38 | $194.86 | $579.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.85 / $461.41 / $816.50
| Professional | | $270.85 | $461.41 | $816.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.46 / $91.21 / $253.27
| Professional | 26 | $82.46 | $91.21 | $253.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.38 / $194.86 / $462.67
| Professional | TC | $188.38 | $194.86 | $462.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.79 / $445.93 / $868.55
| Professional | | $200.79 | $445.93 | $868.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.26 / $92.68 / $269.42
| Professional | 26 | $62.26 | $92.68 | $269.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.83 / $307.61 / $599.13
| Professional | TC | $141.83 | $307.61 | $599.13 |