- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.25 / $179.33 / $230.18
| Professional | | $170.25 | $179.33 | $230.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.89 / $99.61 / $127.86
| Professional | 26 | $92.89 | $99.61 | $127.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.68 / $80.23 / $110.68
| Professional | TC | $75.68 | $80.23 | $110.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.49 / $348.00 / $507.26
| Professional | | $197.49 | $348.00 | $507.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.18 / $185.36 / $237.72
| Professional | 26 | $107.18 | $185.36 | $237.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.37 / $162.97 / $227.99
| Professional | TC | $85.37 | $162.97 | $227.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.94 / $74.72 / $138.75
| Facility | 26 | $69.94 | $74.72 | $138.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $176.00 / $447.50
| Professional | | $104.00 | $176.00 | $447.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.67 / $98.04 / $255.37
| Professional | 26 | $57.67 | $98.04 | $255.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.80 / $66.65 / $178.70
| Professional | TC | $43.80 | $66.65 | $178.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $290.20 / $579.90 / $581.40
| Facility | 26 | $290.20 | $579.90 | $581.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.81 / $1,548.81 / $1,941.23
| Professional | | $1,548.81 | $1,548.81 | $1,941.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $832.85 / $836.46 / $931.13
| Professional | 26 | $832.85 | $836.46 | $931.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $785.37 / $806.89 / $1,010.10
| Professional | TC | $785.37 | $806.89 | $1,010.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.77 / $216.32 / $454.97
| Professional | | $134.77 | $216.32 | $454.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.64 / $121.91 / $253.75
| Professional | 26 | $75.64 | $121.91 | $253.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.88 / $94.80 / $218.36
| Professional | TC | $56.88 | $94.80 | $218.36 |