- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.73 / $85.26 / $99.88
| Professional | | $73.73 | $85.26 | $99.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.16 / $20.81 / $21.59
| Professional | 26 | $18.16 | $20.81 | $21.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.57 / $63.67 / $79.15
| Professional | TC | $55.57 | $63.67 | $79.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.89 / $122.24 / $423.50
| Professional | | $102.89 | $122.24 | $423.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.86 / $143.80 / $423.50
| Professional | | $105.86 | $143.80 | $423.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.00 / $29.08 / $84.65
| Professional | 26 | $27.00 | $29.08 | $84.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $78.84 / $95.58 / $164.26
| Professional | TC | $78.84 | $95.58 | $164.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.86 / $128.31 / $423.50
| Professional | | $105.86 | $128.31 | $423.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.00 / $29.08 / $84.65
| Professional | 26 | $27.00 | $29.08 | $84.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $78.84 / $94.61 / $164.26
| Professional | TC | $78.84 | $94.61 | $164.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.82 / $131.94 / $450.50
| Professional | | $89.82 | $131.94 | $450.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.87 / $30.00 / $90.05
| Professional | 26 | $20.87 | $30.00 | $90.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.59 / $103.16 / $276.33
| Professional | TC | $69.59 | $103.16 | $276.33 |