- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.91 / $69.91 / $69.91
| Facility | 26 | $69.91 | $69.91 | $69.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.44 / $524.50 / $524.50
| Professional | | $369.44 | $524.50 | $524.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.49 / $69.91 / $69.91
| Professional | 26 | $59.49 | $69.91 | $69.91 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $184.72 / $262.25 / $262.25
| Professional | 52 | $184.72 | $262.25 | $262.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $309.95 / $454.59 / $454.59
| Professional | TC | $309.95 | $454.59 | $454.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.36 / $605.72 / $1,423.27
| Professional | | $306.36 | $605.72 | $1,423.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.73 / $85.97 / $212.50
| Professional | 26 | $44.73 | $85.97 | $212.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $261.63 / $516.38 / $786.71
| Professional | TC | $261.63 | $516.38 | $786.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.05 / $664.02 / $940.12
| Professional | | $548.05 | $664.02 | $940.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.50 / $87.44 / $139.37
| Professional | 26 | $79.50 | $87.44 | $139.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $478.13 / $544.38 / $786.71
| Professional | TC | $478.13 | $544.38 | $786.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.64 / $711.84 / $1,690.88
| Professional | | $581.64 | $711.84 | $1,690.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.86 / $113.54 / $254.45
| Professional | 26 | $70.86 | $113.54 | $254.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $494.11 / $594.37 / $1,436.43
| Professional | TC | $494.11 | $594.37 | $1,436.43 |