- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $67.61 / $234.42
| Professional | | $47.86 | $67.61 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $50.12 / $158.49
| Professional | 26 | $32.36 | $50.12 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $19.95 / $25.12
| Professional | TC | $15.14 | $19.95 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | 26 | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $275.42
| Professional | | $77.62 | $77.62 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $89.13 / $275.42
| Professional | | $79.43 | $89.13 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $61.66 / $190.55
| Professional | 26 | $53.70 | $61.66 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $26.30 / $60.26
| Professional | TC | $25.12 | $26.30 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Professional | 26 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $85.11 / $288.40
| Professional | | $61.66 | $85.11 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $60.26 / $109.65
| Professional | 26 | $43.65 | $60.26 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $26.92 / $51.29
| Professional | TC | $18.62 | $26.92 | $51.29 |