- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.33 / $180.19 / $182.14
| Professional | | $154.33 | $180.19 | $182.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.89 / $49.30 / $51.31
| Professional | 26 | $42.89 | $49.30 | $51.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $111.43 / $128.88 / $132.85
| Professional | TC | $111.43 | $128.88 | $132.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.65 / $206.65 / $674.66
| Professional | | $206.65 | $206.65 | $674.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.49 / $60.49 / $197.94
| Professional | 26 | $60.49 | $60.49 | $197.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $146.08 / $146.08 / $146.08
| Professional | TC | $146.08 | $146.08 | $146.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.09 / $235.57 / $674.66
| Professional | | $223.09 | $235.57 | $674.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.98 / $68.03 / $197.94
| Professional | 26 | $63.98 | $68.03 | $197.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $158.41 / $168.01 / $307.05
| Professional | TC | $158.41 | $168.01 | $307.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.39 / $235.57 / $674.66
| Professional | | $222.39 | $235.57 | $674.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.98 / $68.03 / $197.94
| Professional | 26 | $63.98 | $68.03 | $197.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $158.41 / $166.79 / $270.49
| Professional | TC | $158.41 | $166.79 | $270.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.97 / $245.35 / $717.66
| Professional | | $188.97 | $245.35 | $717.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.74 / $73.22 / $210.56
| Professional | 26 | $55.74 | $73.22 | $210.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.01 / $174.22 / $507.10
| Professional | TC | $138.01 | $174.22 | $507.10 |