- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.40 / $110.44 / $162.35
| Professional | | $89.40 | $110.44 | $162.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.72 / $35.13 / $40.06
| Professional | 26 | $26.72 | $35.13 | $40.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.27 / $95.79 / $122.29
| Professional | TC | $54.27 | $95.79 | $122.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.61 / $42.76 / $42.76
| Professional | 26 | $38.61 | $42.76 | $42.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.32 / $111.32 / $131.36
| Professional | | $111.32 | $111.32 | $131.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.15 / $46.15 / $54.46
| Professional | 26 | $46.15 | $46.15 | $54.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.17 / $65.17 / $76.90
| Professional | TC | $65.17 | $65.17 | $76.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.60 / $66.55 / $113.81
| Professional | | $50.60 | $66.55 | $113.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.55 / $21.03 / $60.06
| Professional | 26 | $16.55 | $21.03 | $60.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.57 / $49.04 / $61.82
| Professional | TC | $29.57 | $49.04 | $61.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.23 / $77.09 / $128.76
| Professional | | $70.23 | $77.09 | $128.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.76 / $33.27 / $41.47
| Professional | 26 | $21.76 | $33.27 | $41.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.90 / $48.47 / $90.95
| Professional | TC | $39.90 | $48.47 | $90.95 |