- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.96 / $202.36 / $903.00
| Professional | | $183.96 | $202.36 | $903.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.46 / $25.16 / $57.26
| Professional | 26 | $21.46 | $25.16 | $57.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $161.75 / $171.78 / $275.93
| Professional | TC | $161.75 | $171.78 | $275.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.97 / $351.25 / $720.65
| Professional | | $297.97 | $351.25 | $720.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.38 / $68.81 / $134.52
| Professional | 26 | $58.38 | $68.81 | $134.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $265.79 / $265.79 / $313.30
| Professional | TC | $265.79 | $265.79 | $313.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.90 / $364.06 / $720.65
| Professional | | $220.90 | $364.06 | $720.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $42.01 / $134.52
| Professional | 26 | $30.10 | $42.01 | $134.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $179.68 / $275.22 / $447.90
| Professional | TC | $179.68 | $275.22 | $447.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.90 / $305.32 / $720.65
| Professional | | $220.90 | $305.32 | $720.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $42.01 / $134.52
| Professional | 26 | $30.10 | $42.01 | $134.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $179.68 / $252.03 / $379.61
| Professional | TC | $179.68 | $252.03 | $379.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.40 / $294.22 / $855.33
| Professional | | $210.40 | $294.22 | $855.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.15 / $51.28 / $162.22
| Professional | 26 | $32.15 | $51.28 | $162.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $168.98 / $286.79 / $693.10
| Professional | TC | $168.98 | $286.79 | $693.10 |