- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.16 / $142.82 / $236.34
| Professional | | $92.16 | $142.82 | $236.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.16 / $17.39 / $24.33
| Professional | 26 | $17.16 | $17.39 | $24.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.76 / $125.43 / $174.70
| Professional | TC | $123.76 | $125.43 | $174.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.88 / $84.88 / $84.88
| Professional | | $84.88 | $84.88 | $84.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.15 / $183.05 / $251.35
| Professional | | $24.15 | $183.05 | $251.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.86 / $86.65 / $327.64
| Professional | | $71.86 | $86.65 | $327.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.60 / $30.95 / $76.06
| Professional | 26 | $12.60 | $30.95 | $76.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.33 / $74.16 / $242.52
| Professional | TC | $47.33 | $74.16 | $242.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.78 / $211.15 / $1,336.58
| Professional | | $109.78 | $211.15 | $1,336.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.59 / $35.52 / $315.72
| Professional | 26 | $15.59 | $35.52 | $315.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $78.06 / $175.63 / $1,188.97
| Professional | TC | $78.06 | $175.63 | $1,188.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.85 / $182.97 / $274.45
| Professional | | $93.85 | $182.97 | $274.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.59 / $32.29 / $95.00
| Professional | 26 | $15.59 | $32.29 | $95.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $78.06 / $94.82 / $235.49
| Professional | TC | $78.06 | $94.82 | $235.49 |