- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.01 / $51.47 / $71.22
| Professional | | $44.01 | $51.47 | $71.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.38 / $8.33 / $10.67
| Professional | 26 | $7.38 | $8.33 | $10.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.86 / $43.17 / $60.45
| Professional | TC | $36.86 | $43.17 | $60.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.18 / $41.18 / $102.94
| Professional | | $41.18 | $41.18 | $102.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.74 / $51.17 / $52.23
| Professional | | $43.74 | $51.17 | $52.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $7.29 / $8.34
| Professional | 26 | $6.98 | $7.29 | $8.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.76 / $38.40 / $43.90
| Professional | TC | $36.76 | $38.40 | $43.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.21 / $50.05 / $110.07
| Professional | | $38.21 | $50.05 | $110.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $8.71 / $18.55
| Professional | 26 | $6.98 | $8.71 | $18.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.33 / $41.82 / $91.73
| Professional | TC | $30.33 | $41.82 | $91.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.12 / $100.00 / $100.00
| Facility | 26 | $20.12 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.79 / $49.17 / $343.33
| Professional | | $37.79 | $49.17 | $343.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.48 / $8.91 / $166.76
| Professional | 26 | $7.48 | $8.91 | $166.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.10 / $40.59 / $288.04
| Professional | TC | $30.10 | $40.59 | $288.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.51 / $48.36 / $68.56
| Professional | | $37.51 | $48.36 | $68.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.44 / $8.58 / $12.40
| Professional | 26 | $7.44 | $8.58 | $12.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.93 / $39.68 / $57.19
| Professional | TC | $29.93 | $39.68 | $57.19 |