- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.56 / $193.98 / $591.47
| Professional | | $127.56 | $193.98 | $591.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.05 / $21.86 / $148.47
| Professional | 26 | $18.05 | $21.86 | $148.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $109.50 / $172.12 / $442.99
| Professional | TC | $109.50 | $172.12 | $442.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.27 / $494.45 / $510.17
| Professional | | $441.27 | $494.45 | $510.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.47 / $57.44 / $57.68
| Professional | 26 | $51.47 | $57.44 | $57.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $389.80 / $436.78 / $452.73
| Professional | TC | $389.80 | $436.78 | $452.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $257.99 / $322.49
| Professional | | $257.99 | $257.99 | $322.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.20 / $29.20 / $36.50
| Professional | 26 | $29.20 | $29.20 | $36.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $228.80 / $228.80 / $285.99
| Professional | TC | $228.80 | $228.80 | $285.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.56 / $380.58 / $1,336.58
| Professional | | $219.56 | $380.58 | $1,336.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.18 / $54.04 / $315.72
| Professional | 26 | $31.18 | $54.04 | $315.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.38 / $326.54 / $1,188.97
| Professional | TC | $188.38 | $326.54 | $1,188.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.03 / $186.63 / $402.94
| Professional | | $75.03 | $186.63 | $402.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.59 / $40.47 / $56.57
| Professional | 26 | $15.59 | $40.47 | $56.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $160.13 / $188.38 / $346.37
| Professional | TC | $160.13 | $188.38 | $346.37 |