- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.42 / $96.68 / $132.11
| Professional | | $77.42 | $96.68 | $132.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.45 / $16.94 / $22.76
| Professional | 26 | $15.45 | $16.94 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.70 / $79.75 / $109.35
| Professional | TC | $60.70 | $79.75 | $109.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.17 / $116.26 / $230.30
| Professional | | $76.17 | $116.26 | $230.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.19 / $28.29 / $45.83
| Professional | 26 | $17.19 | $28.29 | $45.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $59.70 / $91.21 / $204.18
| Professional | TC | $59.70 | $91.21 | $204.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.56 / $112.15 / $211.26
| Professional | | $65.56 | $112.15 | $211.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.30 / $26.24 / $42.59
| Professional | 26 | $16.30 | $26.24 | $42.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.64 / $90.13 / $170.93
| Professional | TC | $46.64 | $90.13 | $170.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.09 / $751.09 / $924.90
| Professional | | $751.09 | $751.09 | $924.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $205.00 / $205.00 / $205.00
| Professional | 26 | $205.00 | $205.00 | $205.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $630.88 / $630.88 / $773.40
| Professional | TC | $630.88 | $630.88 | $773.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.40 / $107.90 / $202.70
| Professional | | $67.40 | $107.90 | $202.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.80 / $21.96 / $38.89
| Professional | 26 | $17.80 | $21.96 | $38.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.09 / $87.95 / $164.51
| Professional | TC | $49.09 | $87.95 | $164.51 |