- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.47 / $109.03 / $128.91
| Professional | | $86.47 | $109.03 | $128.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.07 / $42.18 / $46.21
| Professional | 26 | $31.07 | $42.18 | $46.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.40 / $71.56 / $85.09
| Professional | TC | $55.40 | $71.56 | $85.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.88 / $122.88 / $122.88
| Professional | | $122.88 | $122.88 | $122.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.53 / $44.53 / $49.35
| Professional | 26 | $44.53 | $44.53 | $49.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.13 / $137.13 / $161.83
| Professional | | $137.13 | $137.13 | $161.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.32 / $49.32 / $58.20
| Professional | 26 | $49.32 | $49.32 | $58.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $87.82 / $87.82 / $103.63
| Professional | TC | $87.82 | $87.82 | $103.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.96 / $62.33 / $142.16
| Professional | | $52.96 | $62.33 | $142.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.10 / $26.74 / $70.45
| Professional | 26 | $19.10 | $26.74 | $70.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.81 / $40.32 / $94.38
| Professional | TC | $30.81 | $40.32 | $94.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.92 / $89.06 / $137.21
| Professional | | $69.92 | $89.06 | $137.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.49 / $41.14 / $58.68
| Professional | 26 | $25.49 | $41.14 | $58.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.43 / $50.02 / $83.37
| Professional | TC | $44.43 | $50.02 | $83.37 |