- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $91.20 / $218.78
| Professional | | $61.66 | $91.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $23.99 / $66.07
| Professional | 26 | $20.89 | $23.99 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $66.07 / $154.88
| Professional | TC | $39.81 | $66.07 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $338.84 / $338.84
| Professional | | $295.12 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $85.11 / $85.11
| Professional | 26 | $74.13 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $251.19 / $251.19
| Professional | TC | $223.87 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $218.78
| Professional | | $173.78 | $173.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $42.66 / $53.70
| Professional | 26 | $42.66 | $42.66 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.82 / $128.82 / $162.18
| Professional | TC | $128.82 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $257.04 / $724.44
| Professional | | $213.80 | $257.04 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $74.13 / $199.53
| Professional | 26 | $66.07 | $74.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.36 / $181.97 / $537.03
| Professional | TC | $151.36 | $181.97 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $239.88 / $346.74
| Professional | | $117.49 | $239.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $67.61 / $87.10
| Professional | 26 | $33.88 | $67.61 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.18 / $173.78 / $263.03
| Professional | TC | $83.18 | $173.78 | $263.03 |