- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.64 / $71.30 / $72.25
| Professional | | $61.64 | $71.30 | $72.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.61 / $17.72 / $18.57
| Professional | 26 | $15.61 | $17.72 | $18.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.00 / $52.72 / $54.32
| Professional | TC | $46.00 | $52.72 | $54.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.43 / $101.88 / $337.58
| Professional | | $86.43 | $101.88 | $337.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.24 / $25.05 / $72.38
| Professional | 26 | $21.24 | $25.05 | $72.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.01 / $65.01 / $76.63
| Professional | TC | $65.01 | $65.01 | $76.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.50 / $117.05 / $337.58
| Professional | | $88.50 | $117.05 | $337.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.21 / $24.88 / $72.38
| Professional | 26 | $23.21 | $24.88 | $72.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.28 / $80.78 / $136.69
| Professional | TC | $65.28 | $80.78 | $136.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.50 / $107.27 / $337.58
| Professional | | $88.50 | $107.27 | $337.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.21 / $24.88 / $72.38
| Professional | 26 | $23.21 | $24.88 | $72.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.28 / $79.13 / $136.69
| Professional | TC | $65.28 | $79.13 | $136.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.77 / $110.27 / $359.10
| Professional | | $75.77 | $110.27 | $359.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.93 / $26.53 / $77.00
| Professional | 26 | $17.93 | $26.53 | $77.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.94 / $78.91 / $282.10
| Professional | TC | $57.94 | $78.91 | $282.10 |