- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.04 / $418.50 / $449.55
| Professional | | $340.04 | $418.50 | $449.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.17 / $73.20 / $94.24
| Professional | 26 | $62.17 | $73.20 | $94.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $277.86 / $345.93 / $364.62
| Professional | TC | $277.86 | $345.93 | $364.62 |
- 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
- $422.36 / $980.39 / $1,599.00
| Professional | | $422.36 | $980.39 | $1,599.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.21 / $115.77 / $321.33
| Professional | 26 | $98.21 | $115.77 | $321.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $331.70 / $331.70 / $374.17
| Professional | TC | $331.70 | $331.70 | $374.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.49 / $524.79 / $980.39
| Professional | | $324.49 | $524.79 | $980.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.07 / $113.29 / $321.33
| Professional | 26 | $93.07 | $113.29 | $321.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $219.26 / $283.02 / $723.19
| Professional | TC | $219.26 | $283.02 | $723.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.49 / $524.09 / $980.39
| Professional | | $324.49 | $524.09 | $980.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $96.74 / $113.29 / $321.33
| Professional | 26 | $96.74 | $113.29 | $321.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $219.26 / $283.02 / $449.69
| Professional | TC | $219.26 | $283.02 | $449.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.52 / $535.44 / $932.40
| Professional | | $273.52 | $535.44 | $932.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.20 / $110.99 / $341.82
| Professional | 26 | $79.20 | $110.99 | $341.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $165.29 / $359.94 / $701.06
| Professional | TC | $165.29 | $359.94 | $701.06 |