- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.74 / $534.74 / $550.14
| Professional | | $534.74 | $534.74 | $550.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.54 / $76.01 / $76.01
| Professional | 26 | $73.54 | $76.01 | $76.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $458.73 / $458.73 / $476.60
| Professional | TC | $458.73 | $458.73 | $476.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.09 / $611.09 / $1,906.59
| Professional | | $611.09 | $611.09 | $1,906.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.66 / $691.48 / $1,906.59
| Professional | | $640.66 | $691.48 | $1,906.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.21 / $99.61 / $282.58
| Professional | 26 | $93.21 | $99.61 | $282.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $541.05 / $570.46 / $1,291.40
| Professional | TC | $541.05 | $570.46 | $1,291.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.66 / $691.48 / $1,906.59
| Professional | | $640.66 | $691.48 | $1,906.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.21 / $99.61 / $282.58
| Professional | 26 | $93.21 | $99.61 | $282.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $541.05 / $593.04 / $1,291.40
| Professional | TC | $541.05 | $593.04 | $1,291.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.85 / $723.77 / $1,041.27
| Professional | | $482.85 | $723.77 | $1,041.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.01 / $105.88 / $154.33
| Professional | 26 | $70.01 | $105.88 | $154.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $412.84 / $638.29 / $1,072.57
| Professional | TC | $412.84 | $638.29 | $1,072.57 |