- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.68 / $94.73 / $100.19
| Professional | | $81.68 | $94.73 | $100.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.89 / $23.23 / $23.76
| Professional | 26 | $19.89 | $23.23 | $23.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.79 / $70.95 / $76.95
| Professional | TC | $61.79 | $70.95 | $76.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.77 / $135.77 / $135.77
| Facility | 26 | $135.77 | $135.77 | $135.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.36 / $107.36 / $424.35
| Professional | | $107.36 | $107.36 | $424.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.14 / $34.14 / $120.57
| Professional | 26 | $34.14 | $34.14 | $120.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $77.01 / $77.01 / $77.01
| Professional | TC | $77.01 | $77.01 | $77.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.17 / $140.43 / $424.35
| Professional | | $118.17 | $140.43 | $424.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.80 / $41.17 / $120.57
| Professional | 26 | $30.80 | $41.17 | $120.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.56 / $96.15 / $153.72
| Professional | TC | $85.56 | $96.15 | $153.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.22 / $133.30 / $424.35
| Professional | | $108.22 | $133.30 | $424.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.80 / $41.17 / $120.57
| Professional | 26 | $30.80 | $41.17 | $120.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.26 / $90.56 / $150.47
| Professional | TC | $79.26 | $90.56 | $150.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.80 / $125.86 / $366.75
| Professional | | $97.80 | $125.86 | $366.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.15 / $38.97 / $128.25
| Professional | 26 | $29.15 | $38.97 | $128.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.86 / $94.51 / $323.14
| Professional | TC | $68.86 | $94.51 | $323.14 |