- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $104.71 / $204.17
| Professional | | $64.57 | $104.71 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $22.91 / $72.44
| Professional | 26 | $15.14 | $22.91 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.98 / $79.43 / $245.47
| Professional | TC | $48.98 | $79.43 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $426.58
| Professional | | $102.33 | $102.33 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $128.82 / $302.00
| Professional | | $104.71 | $128.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.55 / $28.84 / $61.66
| Professional | 26 | $24.55 | $28.84 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.43 / $97.72 / $245.47
| Professional | TC | $79.43 | $97.72 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $426.58
| Professional | | $81.28 | $81.28 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $20.42 / $85.11
| Professional | 26 | $20.42 | $20.42 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Professional | TC | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $123.03 / $338.84
| Professional | | $95.50 | $123.03 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $29.51 / $67.61
| Professional | 26 | $20.89 | $29.51 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.18 / $91.20 / $275.42
| Professional | TC | $69.18 | $91.20 | $275.42 |