- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.85 / $65.26 / $66.34
| Professional | | $56.85 | $65.26 | $66.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.18 / $37.02 / $37.28
| Professional | 26 | $33.18 | $37.02 | $37.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.67 / $27.98 / $29.33
| Professional | TC | $23.67 | $27.98 | $29.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.00 / $158.00 / $190.00
| Professional | | $126.00 | $158.00 | $190.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.00 / $89.00 / $107.00
| Professional | 26 | $71.00 | $89.00 | $107.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.00 / $69.00 / $83.00
| Professional | TC | $55.00 | $69.00 | $83.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.48 / $159.36 / $277.33
| Professional | | $101.48 | $159.36 | $277.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.31 / $87.45 / $156.22
| Professional | 26 | $57.31 | $87.45 | $156.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.17 / $71.91 / $225.35
| Professional | TC | $44.17 | $71.91 | $225.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.52 / $142.08 / $555.92
| Professional | | $107.52 | $142.08 | $555.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.61 / $81.41 / $240.90
| Professional | 26 | $61.61 | $81.41 | $240.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.91 / $63.62 / $366.30
| Professional | TC | $45.91 | $63.62 | $366.30 |