- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.63 / $112.65 / $283.36
| Professional | | $44.63 | $112.65 | $283.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.18 / $29.52 / $132.00
| Professional | 26 | $21.18 | $29.52 | $132.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $76.16 / $94.41
| Professional | TC | $23.44 | $76.16 | $94.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $171.82 / $171.82 / $171.82
| Facility | 26 | $171.82 | $171.82 | $171.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.22 / $94.56 / $249.97
| Professional | | $80.22 | $94.56 | $249.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.40 / $44.08 / $114.85
| Professional | 26 | $37.40 | $44.08 | $114.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.04 / $48.37 / $48.37
| Professional | TC | $41.04 | $48.37 | $48.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.56 / $132.86 / $249.97
| Professional | | $79.56 | $132.86 | $249.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.76 / $39.79 / $114.85
| Professional | 26 | $33.76 | $39.79 | $114.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.22 / $67.77 / $122.46
| Professional | TC | $40.22 | $67.77 | $122.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.16 / $110.52 / $249.97
| Professional | | $72.16 | $110.52 | $249.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.51 / $39.79 / $114.85
| Professional | 26 | $32.51 | $39.79 | $114.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.97 / $48.78 / $121.11
| Professional | TC | $36.97 | $48.78 | $121.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.46 / $109.74 / $165.51
| Professional | | $58.46 | $109.74 | $165.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.59 / $37.58 / $62.73
| Professional | 26 | $29.59 | $37.58 | $62.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.32 / $73.79 / $119.97
| Professional | TC | $30.32 | $73.79 | $119.97 |