- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.40 / $111.67 / $146.15
| Professional | | $89.40 | $111.67 | $146.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.14 / $37.99 / $96.12
| Professional | 26 | $26.14 | $37.99 | $96.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.27 / $78.45 / $174.91
| Professional | TC | $54.27 | $78.45 | $174.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.74 / $367.24 / $380.09
| Professional | | $327.74 | $367.24 | $380.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.72 / $87.84 / $88.21
| Professional | 26 | $78.72 | $87.84 | $88.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $249.02 / $279.02 / $292.25
| Professional | TC | $249.02 | $279.02 | $292.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.75 / $191.75 / $239.69
| Professional | | $191.75 | $191.75 | $239.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.32 / $45.32 / $56.65
| Professional | 26 | $45.32 | $45.32 | $56.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $146.43 / $146.43 / $183.04
| Professional | TC | $146.43 | $146.43 | $183.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.18 / $283.01 / $973.09
| Professional | | $154.18 | $283.01 | $973.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.04 / $81.97 / $236.03
| Professional | 26 | $45.04 | $81.97 | $236.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $109.14 / $201.04 / $750.23
| Professional | TC | $109.14 | $201.04 | $750.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.05 / $267.24 / $385.04
| Professional | | $131.05 | $267.24 | $385.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.28 / $78.06 / $81.97
| Professional | 26 | $38.28 | $78.06 | $81.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.57 / $197.06 / $312.33
| Professional | TC | $54.57 | $197.06 | $312.33 |