- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.20 / $339.20 / $342.11
| Professional | | $339.20 | $339.20 | $342.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.15 / $51.84 / $51.84
| Professional | 26 | $49.15 | $51.84 | $51.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $287.36 / $287.36 / $292.95
| Professional | TC | $287.36 | $287.36 | $292.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.20 / $70.20 / $70.20
| Facility | 26 | $70.20 | $70.20 | $70.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.80 / $403.80 / $1,318.73
| Professional | | $403.80 | $403.80 | $1,318.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.71 / $61.71 / $207.97
| Professional | 26 | $61.71 | $61.71 | $207.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $342.09 / $342.09 / $342.09
| Professional | TC | $342.09 | $342.09 | $342.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.24 / $477.47 / $1,318.73
| Professional | | $434.24 | $477.47 | $1,318.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.48 / $72.05 / $207.97
| Professional | 26 | $68.48 | $72.05 | $207.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $362.76 / $401.16 / $1,070.82
| Professional | TC | $362.76 | $401.16 | $1,070.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.24 / $477.47 / $1,318.73
| Professional | | $434.24 | $477.47 | $1,318.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.48 / $72.05 / $207.97
| Professional | 26 | $68.48 | $72.05 | $207.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $362.76 / $405.41 / $1,070.82
| Professional | TC | $362.76 | $405.41 | $1,070.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.58 / $486.58 / $720.22
| Professional | | $324.58 | $486.58 | $720.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.32 / $76.12 / $113.58
| Professional | 26 | $50.32 | $76.12 | $113.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $274.26 / $410.46 / $606.64
| Professional | TC | $274.26 | $410.46 | $606.64 |