- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.30 / $283.61 / $359.89
| Professional | | $255.30 | $283.61 | $359.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.07 / $58.49 / $68.40
| Professional | 26 | $50.07 | $58.49 | $68.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.21 / $230.79 / $291.50
| Professional | TC | $188.21 | $230.79 | $291.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $340.53 / $340.53 / $340.53
| Facility | 26 | $340.53 | $340.53 | $340.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.23 / $359.80 / $892.86
| Professional | | $305.23 | $359.80 | $892.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.73 / $423.07 / $892.86
| Professional | | $295.73 | $423.07 | $892.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.63 / $81.34 / $230.98
| Professional | 26 | $71.63 | $81.34 | $230.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $220.21 / $227.94 / $576.29
| Professional | TC | $220.21 | $227.94 | $576.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.73 / $419.26 / $892.86
| Professional | | $295.73 | $419.26 | $892.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.52 / $81.34 / $230.98
| Professional | 26 | $75.52 | $81.34 | $230.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $220.21 / $227.94 / $374.28
| Professional | TC | $220.21 | $227.94 | $374.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.92 / $452.52 / $949.77
| Professional | | $225.92 | $452.52 | $949.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $81.99 / $245.70
| Professional | 26 | $56.23 | $81.99 | $245.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $166.73 / $342.73 / $704.07
| Professional | TC | $166.73 | $342.73 | $704.07 |