- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.40 / $160.31 / $179.94
| Professional | | $134.40 | $160.31 | $179.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.10 / $53.10 / $62.91
| Professional | 26 | $46.10 | $53.10 | $62.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $88.29 / $107.19 / $117.18
| Professional | TC | $88.29 | $107.19 | $117.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.74 / $168.74 / $606.21
| Professional | | $168.74 | $168.74 | $606.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.19 / $57.19 / $215.24
| Professional | 26 | $57.19 | $57.19 | $215.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $111.56 / $111.56 / $111.56
| Professional | TC | $111.56 | $111.56 | $111.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.63 / $211.59 / $606.21
| Professional | | $201.63 | $211.59 | $606.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.47 / $75.78 / $215.24
| Professional | 26 | $67.47 | $75.78 | $215.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $130.80 / $134.08 / $253.52
| Professional | TC | $130.80 | $134.08 | $253.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.63 / $211.32 / $606.21
| Professional | | $201.63 | $211.32 | $606.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.40 / $75.78 / $215.24
| Professional | 26 | $69.40 | $75.78 | $215.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $130.80 / $134.08 / $226.70
| Professional | TC | $130.80 | $134.08 | $226.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.22 / $238.25 / $644.85
| Professional | | $150.22 | $238.25 | $644.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.24 / $75.39 / $201.94
| Professional | 26 | $52.24 | $75.39 | $201.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $98.52 / $152.28 / $415.89
| Professional | TC | $98.52 | $152.28 | $415.89 |