- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.22 / $187.02 / $207.46
| Professional | | $85.22 | $187.02 | $207.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.84 / $56.49 / $62.66
| Professional | 26 | $24.84 | $56.49 | $62.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.38 / $130.53 / $144.80
| Professional | TC | $60.38 | $130.53 | $144.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.10 / $60.09 / $156.36
| Professional | | $36.10 | $60.09 | $156.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.91 / $35.81 / $62.81
| Professional | 26 | $12.91 | $35.81 | $62.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.19 / $61.38 / $123.84
| Professional | TC | $23.19 | $61.38 | $123.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $103.18 / $186.51
| Professional | | $56.33 | $103.18 | $186.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.42 / $34.31 / $64.09
| Professional | 26 | $18.42 | $34.31 | $64.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.67 / $82.65 / $140.51
| Professional | TC | $39.67 | $82.65 | $140.51 |