- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.50 / $235.13 / $257.94
| Professional | | $193.50 | $235.13 | $257.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.87 / $88.14 / $101.32
| Professional | 26 | $72.87 | $88.14 | $101.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $120.64 / $150.21 / $158.32
| Professional | TC | $120.64 | $150.21 | $158.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.29 / $804.74 / $1,599.00
| Professional | | $237.29 | $804.74 | $1,599.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.61 / $87.61 / $347.27
| Professional | 26 | $87.61 | $87.61 | $347.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $143.44 / $143.44 / $169.09
| Professional | TC | $143.44 | $143.44 | $169.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.70 / $296.93 / $804.74
| Professional | | $264.70 | $296.93 | $804.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.10 / $122.16 / $347.27
| Professional | 26 | $107.10 | $122.16 | $347.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.81 / $157.76 / $349.18
| Professional | TC | $151.81 | $157.76 | $349.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.70 / $296.93 / $804.74
| Professional | | $264.70 | $296.93 | $804.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.91 / $122.16 / $347.27
| Professional | 26 | $112.91 | $122.16 | $347.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.81 / $157.76 / $255.89
| Professional | TC | $151.81 | $157.76 | $255.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.20 / $346.04 / $760.39
| Professional | | $218.20 | $346.04 | $760.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.33 / $128.44 / $329.89
| Professional | 26 | $85.33 | $128.44 | $329.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.04 / $205.86 / $486.63
| Professional | TC | $114.04 | $205.86 | $486.63 |