- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $114.82 / $158.49
| Professional | | $89.13 | $114.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $38.90 / $100.00
| Professional | 26 | $26.92 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.66 / $79.43 / $112.20
| Professional | TC | $61.66 | $79.43 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $478.63
| Professional | | $131.83 | $131.83 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $41.69 / $138.04
| Professional | 26 | $41.69 | $41.69 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $91.20 / $91.20 / $107.15
| Professional | TC | $91.20 | $91.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $158.49 / $338.84
| Professional | | $141.25 | $158.49 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $48.98 / $104.71
| Professional | 26 | $45.71 | $48.98 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $97.72 / $104.71 / $223.87
| Professional | TC | $97.72 | $104.71 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $478.63
| Professional | | $109.65 | $109.65 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $35.48 / $138.04
| Professional | 26 | $35.48 | $35.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Professional | TC | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $158.49 / $380.19
| Professional | | $109.65 | $158.49 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $48.98 / $112.20
| Professional | 26 | $35.48 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.13 / $104.71 / $269.15
| Professional | TC | $74.13 | $104.71 | $269.15 |