- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.69 / $394.63 / $688.66
| Professional | | $222.69 | $394.63 | $688.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $123.91 / $144.49 / $302.83
| Professional | 26 | $123.91 | $144.49 | $302.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $98.78 / $148.03 / $502.33
| Professional | TC | $98.78 | $148.03 | $502.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $161.07 / $161.07 / $161.07
| Professional | 26 | $161.07 | $161.07 | $161.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.52 / $337.01 / $661.35
| Professional | | $322.52 | $337.01 | $661.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $157.11 / $161.31 / $189.49
| Professional | 26 | $157.11 | $161.31 | $189.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $165.41 / $175.70 / $471.87
| Professional | TC | $165.41 | $175.70 | $471.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.95 / $170.95 / $170.95
| Facility | | $170.95 | $170.95 | $170.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.16 / $326.16 / $326.16
| Professional | | $326.16 | $326.16 | $326.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $153.56 / $153.56 / $153.56
| Professional | 26 | $153.56 | $153.56 | $153.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $172.60 / $172.60 / $172.60
| Professional | TC | $172.60 | $172.60 | $172.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.74 / $499.69 / $1,036.41
| Professional | | $208.74 | $499.69 | $1,036.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.66 / $198.51 / $343.41
| Professional | 26 | $102.66 | $198.51 | $343.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $97.44 / $269.30 / $684.75
| Professional | TC | $97.44 | $269.30 | $684.75 |