- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.11 / $83.16 / $113.30
| Professional | | $66.11 | $83.16 | $113.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.71 / $17.30 / $19.67
| Professional | 26 | $13.71 | $17.30 | $19.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.59 / $64.22 / $93.80
| Professional | TC | $50.59 | $64.22 | $93.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.60 / $96.68 / $120.85
| Professional | | $84.60 | $96.68 | $120.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.01 / $14.87 / $18.59
| Professional | 26 | $13.01 | $14.87 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $71.58 / $81.81 / $102.26
| Professional | TC | $71.58 | $81.81 | $102.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.23 / $103.42 / $202.37
| Professional | | $72.23 | $103.42 | $202.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.09 / $22.27 / $38.65
| Professional | 26 | $16.09 | $22.27 | $38.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.13 / $81.80 / $165.19
| Professional | TC | $54.13 | $81.80 | $165.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.53 / $110.43 / $751.09
| Professional | | $73.53 | $110.43 | $751.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.02 / $19.73 / $205.00
| Professional | 26 | $18.02 | $19.73 | $205.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.34 / $90.94 / $630.88
| Professional | TC | $55.34 | $90.94 | $630.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.72 / $110.43 / $162.02
| Professional | | $70.72 | $110.43 | $162.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.76 / $19.48 / $34.56
| Professional | 26 | $17.76 | $19.48 | $34.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.02 / $88.31 / $129.52
| Professional | TC | $54.02 | $88.31 | $129.52 |