- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $3,388.44
| Professional | | $371.54 | $602.56 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $165.96 / $501.19
| Professional | 26 | $100.00 | $165.96 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $263.03 / $436.52 / $1,258.93
| Professional | TC | $263.03 | $436.52 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Facility | 26 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,819.70
| Professional | | $501.19 | $501.19 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $141.25 / $436.52
| Professional | 26 | $141.25 | $141.25 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $354.81 / $354.81 / $407.38
| Professional | TC | $354.81 | $354.81 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,071.52 / $1,862.09
| Professional | | $467.74 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.83 / $154.88 / $338.84
| Professional | 26 | $131.83 | $154.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $331.13 / $776.25 / $1,584.89
| Professional | TC | $331.13 | $776.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $1,513.56
| Professional | | $524.81 | $524.81 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $112.20 / $436.52
| Professional | 26 | $112.20 | $112.20 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | TC | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $794.33 / $1,621.81
| Professional | | $389.05 | $794.33 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $147.91 / $354.81
| Professional | 26 | $107.15 | $147.91 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $281.84 / $549.54 / $1,202.26
| Professional | TC | $281.84 | $549.54 | $1,202.26 |