- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.61 / $82.84 / $340.90
| Professional | | $36.61 | $82.84 | $340.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.92 / $28.57 / $98.00
| Professional | 26 | $16.92 | $28.57 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.48 / $63.61 / $139.03
| Professional | TC | $18.48 | $63.61 | $139.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.54 / $114.54 / $114.54
| Facility | 26 | $114.54 | $114.54 | $114.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.02 / $120.49 / $206.95
| Professional | | $110.02 | $120.49 | $206.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.08 / $58.34 / $98.95
| Professional | 26 | $28.08 | $58.34 | $98.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.77 / $64.97 / $64.97
| Professional | TC | $56.77 | $64.97 | $64.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.76 / $109.74 / $206.95
| Professional | | $65.76 | $109.74 | $206.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.50 / $34.01 / $98.95
| Professional | 26 | $23.50 | $34.01 | $98.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.36 / $53.99 / $120.54
| Professional | TC | $31.36 | $53.99 | $120.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.73 / $109.74 / $206.95
| Professional | | $59.73 | $109.74 | $206.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.19 / $34.01 / $98.95
| Professional | 26 | $25.19 | $34.01 | $98.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.36 / $38.97 / $120.54
| Professional | TC | $31.36 | $38.97 | $120.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.44 / $98.95 / $149.56
| Professional | | $49.44 | $98.95 | $149.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.72 / $29.81 / $54.04
| Professional | 26 | $23.72 | $29.81 | $54.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.18 / $55.92 / $114.88
| Professional | TC | $24.18 | $55.92 | $114.88 |