- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $2,187.76
| Professional | | $371.54 | $524.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $123.03 / $269.15
| Professional | 26 | $85.11 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $363.08 / $794.33
| Professional | TC | $263.03 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $691.83
| Professional | | $131.83 | $131.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.83 / $131.83 / $162.18
| Facility | 26 | $131.83 | $131.83 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $1,023.29
| Professional | | $371.54 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $104.71 / $239.88
| Professional | 26 | $58.88 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.40 / $489.78 / $794.33
| Professional | TC | $288.40 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $616.60 / $870.96
| Professional | | $588.84 | $616.60 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.83 / $131.83 / $162.18
| Facility | 26 | $131.83 | $131.83 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $954.99
| Professional | | $512.86 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $131.83 / $194.98
| Professional | 26 | $81.28 | $131.83 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $275.42 / $416.87 / $616.60
| Professional | TC | $275.42 | $416.87 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $691.83
| Professional | | $331.13 | $501.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $79.43 / $154.88
| Professional | 26 | $77.62 | $79.43 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $371.54 / $537.03
| Professional | TC | $257.04 | $371.54 | $537.03 |