- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $85.11 / $117.49
| Professional | | $66.07 | $85.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $37.15 / $114.82
| Professional | 26 | $25.70 | $37.15 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $50.12 / $72.44
| Professional | TC | $39.81 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $354.81
| Professional | | $100.00 | $100.00 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $41.69 / $138.04
| Professional | 26 | $41.69 | $41.69 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.54 / $57.54 / $69.18
| Professional | TC | $57.54 | $57.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $117.49 / $251.19
| Professional | | $109.65 | $117.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $48.98 / $104.71
| Professional | 26 | $45.71 | $48.98 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.66 / $67.61 / $144.54
| Professional | TC | $61.66 | $67.61 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $354.81
| Professional | | $83.18 | $83.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $35.48 / $138.04
| Professional | 26 | $35.48 | $35.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Professional | TC | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $281.84
| Professional | | $83.18 | $120.23 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $48.98 / $112.20
| Professional | 26 | $35.48 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.86 / $67.61 / $173.78
| Professional | TC | $47.86 | $67.61 | $173.78 |