- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.19 / $120.29 / $161.91
| Professional | | $85.19 | $120.29 | $161.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.08 / $91.45 / $123.11
| Professional | 26 | $63.08 | $91.45 | $123.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.93 / $30.54 / $38.81
| Professional | TC | $19.93 | $30.54 | $38.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.08 / $113.08 / $113.08
| Professional | | $113.08 | $113.08 | $113.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.88 / $139.85 / $144.84
| Professional | | $111.88 | $139.85 | $144.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.29 / $101.61 / $113.17
| Professional | 26 | $81.29 | $101.61 | $113.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.04 / $38.22 / $39.60
| Professional | TC | $29.04 | $38.22 | $39.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.52 / $73.52 / $73.52
| Professional | 26 | $73.52 | $73.52 | $73.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.57 / $118.56 / $170.85
| Professional | | $82.57 | $118.56 | $170.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.79 / $84.76 / $131.60
| Professional | 26 | $63.79 | $84.76 | $131.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.32 / $30.04 / $42.41
| Professional | TC | $19.32 | $30.04 | $42.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.95 / $91.59 / $147.76
| Professional | | $71.95 | $91.59 | $147.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.66 / $69.33 / $112.34
| Professional | 26 | $54.66 | $69.33 | $112.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.18 / $21.98 / $35.75
| Professional | TC | $16.18 | $21.98 | $35.75 |