- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.03 / $243.53 / $292.43
| Professional | | $182.03 | $243.53 | $292.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.21 / $39.47 / $49.06
| Professional | 26 | $32.21 | $39.47 | $49.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $143.21 / $208.84 / $252.96
| Professional | TC | $143.21 | $208.84 | $252.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.39 / $692.92 / $728.94
| Professional | | $618.39 | $692.92 | $728.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.58 / $102.62 / $103.05
| Professional | 26 | $91.58 | $102.62 | $103.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $526.79 / $590.29 / $625.89
| Professional | TC | $526.79 | $590.29 | $625.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.02 / $363.02 / $453.78
| Professional | | $363.02 | $363.02 | $453.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.73 / $52.73 / $65.91
| Professional | 26 | $52.73 | $52.73 | $65.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $310.29 / $310.29 / $387.86
| Professional | TC | $310.29 | $310.29 | $387.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.91 / $724.38 / $2,077.04
| Professional | | $417.91 | $724.38 | $2,077.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.43 / $96.08 / $267.88
| Professional | 26 | $55.43 | $96.08 | $267.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $362.48 / $628.29 / $1,809.15
| Professional | TC | $362.48 | $628.29 | $1,809.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.96 / $355.23 / $769.94
| Professional | | $208.96 | $355.23 | $769.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.12 / $83.47 / $100.98
| Professional | 26 | $47.12 | $83.47 | $100.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $308.11 / $628.29 / $668.96
| Professional | TC | $308.11 | $628.29 | $668.96 |