- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.18 / $132.77 / $347.20
| Professional | | $90.18 | $132.77 | $347.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.46 / $47.18 / $115.71
| Professional | 26 | $32.46 | $47.18 | $115.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.72 / $85.57 / $231.49
| Professional | TC | $57.72 | $85.57 | $231.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.64 / $294.29 / $302.39
| Professional | | $262.64 | $294.29 | $302.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $94.61 / $106.02 / $106.42
| Professional | 26 | $94.61 | $106.02 | $106.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $168.03 / $188.29 / $195.96
| Professional | TC | $168.03 | $188.29 | $195.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.40 / $153.40 / $191.75
| Professional | | $153.40 | $153.40 | $191.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.48 / $54.48 / $68.09
| Professional | 26 | $54.48 | $54.48 | $68.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $98.93 / $98.93 / $123.66
| Professional | TC | $98.93 | $98.93 | $123.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.04 / $284.42 / $881.27
| Professional | | $155.04 | $284.42 | $881.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.87 / $101.77 / $342.38
| Professional | 26 | $55.87 | $101.77 | $342.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $99.17 / $182.65 / $549.40
| Professional | TC | $99.17 | $182.65 | $549.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.78 / $268.74 / $284.42
| Professional | | $131.78 | $268.74 | $284.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.49 / $96.85 / $101.77
| Professional | 26 | $47.49 | $96.85 | $101.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.58 / $135.72 / $210.99
| Professional | TC | $49.58 | $135.72 | $210.99 |