- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.58 / $300.19 / $436.78
| Professional | | $282.58 | $300.19 | $436.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.29 / $177.96 / $705.76
| Professional | 26 | $27.29 | $177.96 | $705.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $193.47 / $196.09 / $289.80
| Professional | TC | $193.47 | $196.09 | $289.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.86 / $189.86 / $209.13
| Professional | | $189.86 | $189.86 | $209.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.53 / $65.12 / $68.17
| Professional | 26 | $64.53 | $65.12 | $68.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.40 / $401.80 / $551.73
| Professional | | $141.40 | $401.80 | $551.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.72 / $235.20 / $721.17
| Professional | | $158.72 | $235.20 | $721.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.73 / $144.38 / $234.79
| Professional | 26 | $65.73 | $144.38 | $234.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $92.59 / $150.34 / $489.82
| Professional | TC | $92.59 | $150.34 | $489.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.39 / $560.97 / $2,755.28
| Professional | | $183.39 | $560.97 | $2,755.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.38 / $245.65 / $895.79
| Professional | 26 | $89.38 | $245.65 | $895.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $136.75 / $412.50 / $1,859.49
| Professional | TC | $136.75 | $412.50 | $1,859.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.42 / $305.64 / $641.49
| Professional | | $179.42 | $305.64 | $641.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.38 / $137.04 / $729.41
| Professional | 26 | $89.38 | $137.04 | $729.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $100.97 / $253.09 / $419.20
| Professional | TC | $100.97 | $253.09 | $419.20 |