- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.38 / $387.55 / $518.52
| Professional | | $296.38 | $387.55 | $518.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.82 / $45.38 / $51.50
| Professional | 26 | $34.82 | $45.38 | $51.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $261.56 / $341.64 / $467.01
| Professional | TC | $261.56 | $341.64 | $467.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.00 / $672.81 / $672.81
| Professional | | $264.00 | $672.81 | $672.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.43 / $563.80 / $810.75
| Professional | | $261.43 | $563.80 | $810.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.09 / $64.28 / $93.54
| Professional | 26 | $25.09 | $64.28 | $93.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $236.35 / $492.85 / $717.22
| Professional | TC | $236.35 | $492.85 | $717.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.12 / $495.44 / $2,779.34
| Professional | | $376.12 | $495.44 | $2,779.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.53 / $59.27 / $306.82
| Professional | 26 | $30.53 | $59.27 | $306.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.71 / $439.46 / $2,481.83
| Professional | TC | $239.71 | $439.46 | $2,481.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.24 / $433.44 / $589.35
| Professional | | $270.24 | $433.44 | $589.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.53 / $50.89 / $71.25
| Professional | 26 | $30.53 | $50.89 | $71.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.71 / $383.14 / $519.36
| Professional | TC | $239.71 | $383.14 | $519.36 |