- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.00 / $589.00 / $613.49
| Professional | | $589.00 | $589.00 | $613.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $231.59 / $236.86 / $236.86
| Professional | 26 | $231.59 | $236.86 | $236.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $352.14 / $352.14 / $381.89
| Professional | TC | $352.14 | $352.14 | $381.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1,340.82 / $1,340.82 / $1,340.82
| Facility | 26 | $1,340.82 | $1,340.82 | $1,340.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.89 / $672.89 / $2,028.00
| Professional | | $672.89 | $672.89 | $2,028.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $292.61 / $292.61 / $947.73
| Professional | 26 | $292.61 | $292.61 | $947.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $373.43 / $373.43 / $373.43
| Professional | TC | $373.43 | $373.43 | $373.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.96 / $911.30 / $2,028.00
| Professional | | $642.96 | $911.30 | $2,028.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $299.58 / $309.24 / $947.73
| Professional | 26 | $299.58 | $309.24 | $947.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $343.37 / $383.25 / $690.68
| Professional | TC | $343.37 | $383.25 | $690.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.96 / $911.30 / $2,028.00
| Professional | | $642.96 | $911.30 | $2,028.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $299.58 / $309.24 / $947.73
| Professional | 26 | $299.58 | $309.24 | $947.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $343.37 / $383.25 / $690.68
| Professional | TC | $343.37 | $383.25 | $690.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.29 / $1,050.09 / $2,157.26
| Professional | | $640.29 | $1,050.09 | $2,157.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $227.94 / $304.04 / $1,008.14
| Professional | 26 | $227.94 | $304.04 | $1,008.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $259.75 / $437.07 / $1,194.52
| Professional | TC | $259.75 | $437.07 | $1,194.52 |