- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $478.63 / $1,096.48
| Professional | | $208.93 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $125.89 / $389.05
| Professional | 26 | $67.61 | $125.89 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.82 / $257.04 / $512.86
| Professional | TC | $128.82 | $257.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $309.03 / $309.03
| Professional | | $109.65 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $109.65 / $134.90
| Facility | 26 | $109.65 | $109.65 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $467.74 / $707.95
| Professional | | $204.17 | $467.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $91.20 / $194.98
| Professional | 26 | $48.98 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.04 / $316.23 / $562.34
| Professional | TC | $138.04 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $346.74 / $724.44
| Professional | | $331.13 | $346.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $109.65 / $134.90
| Facility | 26 | $109.65 | $109.65 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $467.74 / $575.44
| Professional | | $288.40 | $467.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $109.65 / $158.49
| Professional | 26 | $67.61 | $109.65 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $131.83 / $199.53 / $467.74
| Professional | TC | $131.83 | $199.53 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $338.84 / $549.54
| Professional | | $186.21 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $70.79 / $128.82
| Professional | 26 | $64.57 | $70.79 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.03 / $218.78 / $416.87
| Professional | TC | $123.03 | $218.78 | $416.87 |