- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $295.12
| Professional | | $173.78 | $239.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $33.11 / $45.71
| Professional | 26 | $25.70 | $33.11 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $131.83 / $208.93 / $251.19
| Professional | TC | $131.83 | $208.93 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $691.83 / $707.95
| Professional | | $616.60 | $691.83 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $102.33 / $104.71
| Professional | 26 | $91.20 | $102.33 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $524.81 / $588.84 / $602.56
| Professional | TC | $524.81 | $588.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $457.09
| Professional | | $363.08 | $363.08 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $52.48 / $66.07
| Professional | 26 | $52.48 | $52.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $309.03 / $309.03 / $389.05
| Professional | TC | $309.03 | $309.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $776.25 / $2,089.30
| Professional | | $691.83 | $776.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $100.00 / $269.15
| Professional | 26 | $91.20 | $100.00 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $588.84 / $676.08 / $1,819.70
| Professional | TC | $588.84 | $676.08 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $776.25
| Professional | | $346.74 | $575.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $83.18 / $104.71
| Professional | 26 | $45.71 | $83.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $302.00 / $489.78 / $676.08
| Professional | TC | $302.00 | $489.78 | $676.08 |