- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.80 / $311.04 / $365.22
| Professional | | $290.80 | $311.04 | $365.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.67 / $39.65 / $59.25
| Professional | 26 | $38.67 | $39.65 | $59.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.14 / $272.37 / $317.12
| Professional | TC | $251.14 | $272.37 | $317.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $228.05 / $228.05 / $228.05
| Facility | 26 | $228.05 | $228.05 | $228.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.29 / $365.29 / $1,312.90
| Professional | | $365.29 | $365.29 | $1,312.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.26 / $50.26 / $154.96
| Professional | 26 | $50.26 | $50.26 | $154.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Professional | TC | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.05 / $474.33 / $1,312.90
| Professional | | $336.05 | $474.33 | $1,312.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.64 / $53.25 / $154.96
| Professional | 26 | $48.64 | $53.25 | $154.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $287.41 / $380.17 / $818.08
| Professional | TC | $287.41 | $380.17 | $818.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.05 / $474.33 / $1,312.90
| Professional | | $336.05 | $474.33 | $1,312.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.64 / $53.25 / $154.96
| Professional | 26 | $48.64 | $53.25 | $154.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $287.41 / $421.40 / $818.08
| Professional | TC | $287.41 | $421.40 | $818.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.03 / $356.56 / $717.03
| Professional | | $253.03 | $356.56 | $717.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.77 / $52.54 / $84.63
| Professional | 26 | $37.77 | $52.54 | $84.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $215.26 / $341.38 / $632.40
| Professional | TC | $215.26 | $341.38 | $632.40 |