- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.81 / $109.34 / $129.68
| Professional | | $96.81 | $109.34 | $129.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.42 / $13.99 / $15.40
| Professional | 26 | $11.42 | $13.99 | $15.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.40 / $95.35 / $115.77
| Professional | TC | $85.40 | $95.35 | $115.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $25.01 / $105.97
| Professional | | $10.21 | $25.01 | $105.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.27 / $118.73 / $142.65
| Professional | | $72.27 | $118.73 | $142.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.46 / $16.67 / $22.62
| Professional | 26 | $10.46 | $16.67 | $22.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.87 / $102.61 / $121.74
| Professional | TC | $60.87 | $102.61 | $121.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.29 / $34.29 / $100.00
| Facility | 26 | $34.29 | $34.29 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.73 / $105.72 / $383.24
| Professional | | $79.73 | $105.72 | $383.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.42 / $14.75 / $135.38
| Professional | 26 | $12.42 | $14.75 | $135.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.73 / $88.34 / $706.26
| Professional | TC | $66.73 | $88.34 | $706.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.37 / $97.69 / $131.65
| Professional | | $79.37 | $97.69 | $131.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.95 / $14.06 / $18.63
| Professional | 26 | $11.95 | $14.06 | $18.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $64.69 / $84.08 / $125.74
| Professional | TC | $64.69 | $84.08 | $125.74 |