- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.14 / $507.59 / $549.00
| Professional | | $414.14 | $507.59 | $549.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.37 / $121.89 / $142.49
| Professional | 26 | $104.37 | $121.89 | $142.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $309.76 / $385.70 / $406.51
| Professional | TC | $309.76 | $385.70 | $406.51 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $711.74 / $711.74 / $711.74
| Facility | 26 | $711.74 | $711.74 | $711.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.64 / $621.64 / $1,810.05
| Professional | | $621.64 | $621.64 | $1,810.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.09 / $822.57 / $1,810.05
| Professional | | $554.09 | $822.57 | $1,810.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $150.60 / $166.04 / $469.15
| Professional | 26 | $150.60 | $166.04 | $469.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $359.53 / $461.17 / $1,075.11
| Professional | TC | $359.53 | $461.17 | $1,075.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.29 / $753.27 / $1,810.05
| Professional | | $524.29 | $753.27 | $1,810.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $153.28 / $166.04 / $469.15
| Professional | 26 | $153.28 | $166.04 | $469.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $359.53 / $461.17 / $740.11
| Professional | TC | $359.53 | $461.17 | $740.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.76 / $928.79 / $1,925.42
| Professional | | $450.76 | $928.79 | $1,925.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $115.90 / $167.27 / $499.05
| Professional | 26 | $115.90 | $167.27 | $499.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $329.86 / $710.31 / $1,426.37
| Professional | TC | $329.86 | $710.31 | $1,426.37 |