- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.68 / $70.43 / $74.42
| Professional | | $60.68 | $70.43 | $74.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.71 / $18.38 / $18.76
| Professional | 26 | $15.71 | $18.38 | $18.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.99 / $51.66 / $56.03
| Professional | TC | $44.99 | $51.66 | $56.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $106.07 / $106.07 / $106.07
| Facility | 26 | $106.07 | $106.07 | $106.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.64 / $92.70 / $265.45
| Professional | | $78.64 | $92.70 | $265.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.36 / $23.36 / $60.28
| Professional | 26 | $23.36 | $23.36 | $60.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.50 / $60.50 / $71.31
| Professional | TC | $60.50 | $60.50 | $71.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.70 / $90.57 / $265.45
| Professional | | $76.70 | $90.57 | $265.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.71 / $25.22 / $60.28
| Professional | 26 | $20.71 | $25.22 | $60.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.08 / $69.86 / $111.99
| Professional | TC | $52.08 | $69.86 | $111.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.70 / $90.57 / $265.45
| Professional | | $76.70 | $90.57 | $265.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.71 / $25.22 / $60.28
| Professional | 26 | $20.71 | $25.22 | $60.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.05 / $62.90 / $100.21
| Professional | TC | $52.05 | $62.90 | $100.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.51 / $84.50 / $226.35
| Professional | | $63.51 | $84.50 | $226.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.71 / $24.41 / $57.75
| Professional | 26 | $15.71 | $24.41 | $57.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.20 / $62.94 / $218.25
| Professional | TC | $45.20 | $62.94 | $218.25 |