- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.41 / $283.07 / $379.06
| Professional | | $265.41 | $283.07 | $379.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.86 / $43.94 / $65.79
| Professional | 26 | $42.86 | $43.94 | $65.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $221.47 / $240.20 / $313.25
| Professional | TC | $221.47 | $240.20 | $313.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $251.40 / $251.40 / $251.40
| Facility | 26 | $251.40 | $251.40 | $251.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.21 / $330.21 / $1,174.31
| Professional | | $330.21 | $330.21 | $1,174.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.89 / $54.89 / $167.86
| Professional | 26 | $54.89 | $54.89 | $167.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $284.92 / $284.92 / $284.92
| Professional | TC | $284.92 | $284.92 | $284.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.45 / $428.06 / $1,174.31
| Professional | | $316.45 | $428.06 | $1,174.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.94 / $57.81 / $167.86
| Professional | 26 | $53.94 | $57.81 | $167.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $262.52 / $328.93 / $686.86
| Professional | TC | $262.52 | $328.93 | $686.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.45 / $428.06 / $1,174.31
| Professional | | $316.45 | $428.06 | $1,174.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.94 / $57.81 / $167.86
| Professional | 26 | $53.94 | $57.81 | $167.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $262.52 / $370.25 / $686.86
| Professional | TC | $262.52 | $370.25 | $686.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.52 / $363.99 / $641.34
| Professional | | $229.52 | $363.99 | $641.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.78 / $58.37 / $91.68
| Professional | 26 | $41.78 | $58.37 | $91.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $187.74 / $297.73 / $549.66
| Professional | TC | $187.74 | $297.73 | $549.66 |