- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.98 / $380.98 / $384.26
| Professional | | $380.98 | $380.98 | $384.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.45 / $58.46 / $58.46
| Professional | 26 | $55.45 | $58.46 | $58.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $322.52 / $322.52 / $328.80
| Professional | TC | $322.52 | $322.52 | $328.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.36 / $75.36 / $75.36
| Facility | 26 | $75.36 | $75.36 | $75.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.38 / $450.38 / $1,391.83
| Professional | | $450.38 | $450.38 | $1,391.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.03 / $512.82 / $1,391.83
| Professional | | $460.03 | $512.82 | $1,391.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.25 / $80.37 / $233.85
| Professional | 26 | $77.25 | $80.37 | $233.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $379.91 / $423.87 / $963.27
| Professional | TC | $379.91 | $423.87 | $963.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.03 / $512.82 / $1,391.83
| Professional | | $460.03 | $512.82 | $1,391.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.25 / $80.37 / $233.85
| Professional | 26 | $77.25 | $80.37 | $233.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $379.91 / $433.77 / $963.27
| Professional | TC | $379.91 | $433.77 | $963.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.72 / $564.02 / $760.14
| Professional | | $364.72 | $564.02 | $760.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.76 / $85.87 / $127.72
| Professional | 26 | $56.76 | $85.87 | $127.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $307.95 / $460.89 / $632.41
| Professional | TC | $307.95 | $460.89 | $632.41 |