- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.53 / $100.92 / $244.64
| Professional | | $86.53 | $100.92 | $244.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.22 / $37.99 / $54.55
| Professional | 26 | $32.22 | $37.99 | $54.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.27 / $62.92 / $629.24
| Professional | TC | $54.27 | $62.92 | $629.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.66 / $186.93 / $646.49
| Professional | | $145.66 | $186.93 | $646.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.09 / $159.85 / $646.49
| Professional | | $121.09 | $159.85 | $646.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.44 / $52.23 / $148.32
| Professional | 26 | $43.44 | $52.23 | $148.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.45 / $95.47 / $136.97
| Professional | TC | $69.45 | $95.47 | $136.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.39 / $133.93 / $199.56
| Professional | | $106.39 | $133.93 | $199.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.64 / $49.29 / $64.38
| Professional | 26 | $33.64 | $49.29 | $64.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $63.41 / $95.47 / $136.97
| Professional | TC | $63.41 | $95.47 | $136.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.39 / $128.99 / $458.46
| Professional | | $77.39 | $128.99 | $458.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.48 / $37.47 / $105.18
| Professional | 26 | $22.48 | $37.47 | $105.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.11 / $91.52 / $353.28
| Professional | TC | $57.11 | $91.52 | $353.28 |