- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.00 / $191.30 / $783.22
| Professional | | $78.00 | $191.30 | $783.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.85 / $77.31 / $468.00
| Professional | 26 | $28.85 | $77.31 | $468.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $28.19 / $59.27 / $65.62
| Professional | 52 | $28.19 | $59.27 | $65.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.52 / $77.70 / $338.00
| Professional | TC | $27.52 | $77.70 | $338.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.34 / $121.82 / $252.00
| Professional | | $103.34 | $121.82 | $252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.60 / $105.83 / $252.00
| Professional | | $89.60 | $105.83 | $252.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.12 / $54.20 / $128.25
| Professional | 26 | $45.12 | $54.20 | $128.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.48 / $48.44 / $81.47
| Professional | TC | $44.48 | $48.44 | $81.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.09 / $89.60 / $127.24
| Professional | | $67.09 | $89.60 | $127.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.93 / $45.77 / $57.39
| Professional | 26 | $34.93 | $45.77 | $57.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.24 / $44.48 / $48.84
| Professional | TC | $32.24 | $44.48 | $48.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.91 / $103.69 / $214.17
| Professional | | $42.91 | $103.69 | $214.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.57 / $39.28 / $57.55
| Professional | 26 | $23.57 | $39.28 | $57.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.11 / $32.22 / $104.94
| Professional | TC | $20.11 | $32.22 | $104.94 |