- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.78 / $102.19 / $448.43
| Professional | | $59.78 | $102.19 | $448.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.94 / $46.95 / $305.18
| Professional | 26 | $16.94 | $46.95 | $305.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.11 / $56.83 / $539.80
| Professional | TC | $37.11 | $56.83 | $539.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.12 / $118.01 / $306.00
| Professional | | $100.12 | $118.01 | $306.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.94 / $101.61 / $306.00
| Professional | | $76.94 | $101.61 | $306.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.96 / $32.63 / $97.50
| Professional | 26 | $24.96 | $32.63 | $97.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.98 / $68.98 / $86.44
| Professional | TC | $51.98 | $68.98 | $86.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.70 / $93.48 / $133.46
| Professional | | $67.70 | $93.48 | $133.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.85 / $32.63 / $38.78
| Professional | 26 | $21.85 | $32.63 | $38.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.85 / $66.95 / $86.44
| Professional | TC | $45.85 | $66.95 | $86.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.78 / $94.63 / $260.19
| Professional | | $56.78 | $94.63 | $260.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.71 / $29.51 / $82.83
| Professional | 26 | $17.71 | $29.51 | $82.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.07 / $65.12 / $177.36
| Professional | TC | $39.07 | $65.12 | $177.36 |