- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.43 / $103.71 / $449.15
| Professional | | $59.43 | $103.71 | $449.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.49 / $29.66 / $159.00
| Professional | 26 | $23.49 | $29.66 | $159.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.47 / $78.92 / $98.28
| Professional | TC | $22.47 | $78.92 | $98.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.41 / $125.43 / $227.26
| Professional | | $106.41 | $125.43 | $227.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.74 / $46.74 / $180.72
| Professional | 26 | $31.74 | $46.74 | $180.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.88 / $26.88 / $63.64
| Professional | TC | $26.88 | $26.88 | $63.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.56 / $161.91 / $301.02
| Professional | | $77.56 | $161.91 | $301.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.72 / $51.12 / $180.72
| Professional | 26 | $36.72 | $51.12 | $180.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.45 / $105.07 / $228.41
| Professional | TC | $15.45 | $105.07 | $228.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.56 / $157.94 / $227.26
| Professional | | $77.56 | $157.94 | $227.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.32 / $47.66 / $180.72
| Professional | 26 | $39.32 | $47.66 | $180.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.92 / $97.96 / $143.80
| Professional | TC | $14.92 | $97.96 | $143.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.04 / $117.67 / $223.60
| Professional | | $79.04 | $117.67 | $223.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.39 / $43.69 / $98.70
| Professional | 26 | $30.39 | $43.69 | $98.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.41 / $56.57 / $138.24
| Professional | TC | $25.41 | $56.57 | $138.24 |