- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.16 / $556.16 / $594.37
| Professional | | $556.16 | $556.16 | $594.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.06 / $80.91 / $80.91
| Professional | 26 | $79.06 | $80.91 | $80.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $475.26 / $475.26 / $515.29
| Professional | TC | $475.26 | $475.26 | $515.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $457.21 / $457.21 / $457.21
| Facility | 26 | $457.21 | $457.21 | $457.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.97 / $576.97 / $1,930.02
| Professional | | $576.97 | $576.97 | $1,930.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.03 / $102.03 / $346.30
| Professional | 26 | $102.03 | $102.03 | $346.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $495.90 / $495.90 / $495.90
| Professional | TC | $495.90 | $495.90 | $495.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.55 / $714.50 / $1,930.02
| Professional | | $584.55 | $714.50 | $1,930.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.88 / $111.37 / $346.30
| Professional | 26 | $106.88 | $111.37 | $346.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $475.42 / $597.32 / $949.66
| Professional | TC | $475.42 | $597.32 | $949.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.55 / $714.50 / $1,930.02
| Professional | | $584.55 | $714.50 | $1,930.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.88 / $111.37 / $346.30
| Professional | 26 | $106.88 | $111.37 | $346.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $475.42 / $597.32 / $949.66
| Professional | TC | $475.42 | $597.32 | $949.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.06 / $585.70 / $1,054.07
| Professional | | $486.06 | $585.70 | $1,054.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.00 / $108.72 / $189.13
| Professional | 26 | $78.00 | $108.72 | $189.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $408.06 / $548.28 / $1,684.67
| Professional | TC | $408.06 | $548.28 | $1,684.67 |