- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.40 / $103.15 / $235.96
| Professional | | $79.40 | $103.15 | $235.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.40 / $27.93 / $51.69
| Professional | 26 | $23.40 | $27.93 | $51.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.00 / $75.22 / $184.26
| Professional | TC | $56.00 | $75.22 | $184.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.67 / $35.67 / $35.67
| Professional | 26 | $35.67 | $35.67 | $35.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.62 / $143.62 / $208.27
| Professional | | $143.62 | $143.62 | $208.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.20 / $114.02 / $208.97
| Professional | | $51.20 | $114.02 | $208.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.46 / $32.07 / $63.03
| Professional | 26 | $16.46 | $32.07 | $63.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.76 / $81.95 / $145.94
| Professional | TC | $35.76 | $81.95 | $145.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.94 / $116.57 / $730.19
| Professional | | $69.94 | $116.57 | $730.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.81 / $37.31 / $200.25
| Professional | 26 | $20.81 | $37.31 | $200.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.44 / $82.65 / $531.07
| Professional | TC | $46.44 | $82.65 | $531.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.94 / $112.84 / $157.43
| Professional | | $69.94 | $112.84 | $157.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.81 / $33.92 / $47.14
| Professional | 26 | $20.81 | $33.92 | $47.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.59 / $79.26 / $107.44
| Professional | TC | $49.59 | $79.26 | $107.44 |