- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $95.50 / $371.54
| Professional | | $72.44 | $95.50 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $44.67 / $138.04
| Professional | 26 | $35.48 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.36 / $50.12 / $104.71
| Professional | TC | $32.36 | $50.12 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Facility | 26 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $114.82 / $323.59
| Professional | | $97.72 | $114.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $56.23 / $158.49
| Professional | 26 | $47.86 | $56.23 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.65 / $43.65 / $51.29
| Professional | TC | $43.65 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $147.91 / $257.04
| Professional | | $95.50 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $57.54 / $117.49
| Professional | 26 | $51.29 | $57.54 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.65 / $87.10 / $138.04
| Professional | TC | $43.65 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $323.59
| Professional | | $83.18 | $83.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $39.81 / $158.49
| Professional | 26 | $39.81 | $39.81 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Professional | TC | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $102.33 / $275.42
| Professional | | $70.79 | $102.33 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $53.70 / $128.82
| Professional | 26 | $38.90 | $53.70 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $63.10 / $173.78
| Professional | TC | $31.62 | $63.10 | $173.78 |