- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.23 / $70.40 / $172.66
| Professional | | $64.23 | $70.40 | $172.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.36 / $38.43 / $40.28
| Professional | 26 | $36.36 | $38.43 | $40.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.80 / $30.13 / $30.13
| Professional | TC | $25.80 | $30.13 | $30.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.88 / $147.75 / $161.99
| Professional | | $122.88 | $147.75 | $161.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.13 / $84.32 / $92.45
| Professional | 26 | $70.13 | $84.32 | $92.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.76 / $63.43 / $69.55
| Professional | TC | $52.76 | $63.43 | $69.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.57 / $123.90 / $212.42
| Professional | | $56.57 | $123.90 | $212.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.11 / $70.34 / $120.59
| Professional | 26 | $32.11 | $70.34 | $120.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.76 / $53.56 / $91.83
| Professional | TC | $19.76 | $53.56 | $91.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.85 / $103.95 / $396.08
| Professional | | $55.85 | $103.95 | $396.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $62.34 / $347.34
| Professional | 26 | $33.11 | $62.34 | $347.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.73 / $42.80 / $166.53
| Professional | TC | $22.73 | $42.80 | $166.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.91 / $79.48 / $128.99
| Professional | | $54.91 | $79.48 | $128.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.83 / $45.35 / $76.95
| Professional | 26 | $32.83 | $45.35 | $76.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.73 / $34.13 / $53.50
| Professional | TC | $22.73 | $34.13 | $53.50 |