- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.20 / $333.44 / $510.16
| Professional | | $265.20 | $333.44 | $510.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.35 / $60.10 / $82.46
| Professional | 26 | $46.35 | $60.10 | $82.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.31 / $279.54 / $427.69
| Professional | TC | $194.31 | $279.54 | $427.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.47 / $67.78 / $98.52
| Professional | 26 | $29.47 | $67.78 | $98.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.52 / $467.17 / $467.17
| Professional | | $258.52 | $467.17 | $467.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.87 / $407.65 / $766.26
| Professional | | $186.87 | $407.65 | $766.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.58 / $81.55 / $123.87
| Professional | 26 | $32.58 | $81.55 | $123.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $154.28 / $343.85 / $642.39
| Professional | TC | $154.28 | $343.85 | $642.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.27 / $411.78 / $2,575.76
| Professional | | $222.27 | $411.78 | $2,575.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.50 / $79.27 / $393.91
| Professional | 26 | $40.50 | $79.27 | $393.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.53 / $344.29 / $2,181.85
| Professional | TC | $141.53 | $344.29 | $2,181.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.86 / $397.00 / $540.83
| Professional | | $220.86 | $397.00 | $540.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.50 / $68.48 / $94.49
| Professional | 26 | $40.50 | $68.48 | $94.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.53 / $330.19 / $447.57
| Professional | TC | $141.53 | $330.19 | $447.57 |