- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $208.93 / $616.60
| Professional | | $60.26 | $208.93 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $77.62 / $239.88
| Professional | 26 | $34.67 | $77.62 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $95.50 / $199.53
| Professional | TC | $25.70 | $95.50 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $363.08
| Facility | | $190.55 | $309.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $79.43 / $165.96
| Professional | | $60.26 | $79.43 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.62 / $41.69 / $93.33
| Professional | 26 | $31.62 | $41.69 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $29.51 / $46.77
| Professional | TC | $24.55 | $29.51 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $131.83 / $323.59
| Professional | | $79.43 | $131.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $77.62 / $181.97
| Professional | 26 | $44.67 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.67 / $61.66 / $288.40
| Professional | TC | $34.67 | $61.66 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,412.54 / $6,456.54
| Facility | | $316.23 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $114.82 / $281.84
| Professional | | $72.44 | $114.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $58.88 / $123.03
| Professional | 26 | $40.74 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $50.12 / $169.82
| Professional | TC | $30.90 | $50.12 | $169.82 |