- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.81 / $409.05 / $519.41
| Professional | | $317.81 | $409.05 | $519.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.23 / $96.08 / $112.30
| Professional | 26 | $82.23 | $96.08 | $112.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $225.56 / $322.32 / $407.11
| Professional | TC | $225.56 | $322.32 | $407.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $559.01 / $559.01 / $559.01
| Facility | 26 | $559.01 | $559.01 | $559.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.38 / $1,358.03 / $1,599.00
| Professional | | $586.38 | $1,358.03 | $1,599.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $119.03 / $140.31 / $360.17
| Professional | 26 | $119.03 | $140.31 | $360.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $455.54 / $455.54 / $536.98
| Professional | TC | $455.54 | $455.54 | $536.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.36 / $722.50 / $1,358.03
| Professional | | $407.36 | $722.50 | $1,358.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.05 / $127.25 / $360.17
| Professional | 26 | $117.05 | $127.25 | $360.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $290.32 / $339.45 / $891.17
| Professional | TC | $290.32 | $339.45 | $891.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.36 / $661.75 / $1,358.03
| Professional | | $407.36 | $661.75 | $1,358.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.05 / $127.25 / $360.17
| Professional | 26 | $117.05 | $127.25 | $360.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $290.32 / $339.45 / $613.26
| Professional | TC | $290.32 | $339.45 | $613.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.42 / $740.96 / $1,233.10
| Professional | | $328.42 | $740.96 | $1,233.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.60 / $128.21 / $383.13
| Professional | 26 | $92.60 | $128.21 | $383.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $235.67 / $544.97 / $1,061.46
| Professional | TC | $235.67 | $544.97 | $1,061.46 |