- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $87.10 / $173.78
| Professional | | $66.07 | $87.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $46.77 / $131.83
| Professional | 26 | $38.02 | $46.77 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $40.74 / $107.15
| Professional | TC | $22.91 | $40.74 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $91.20 / $186.21
| Professional | | $77.62 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $56.23 / $91.20
| Professional | 26 | $38.90 | $56.23 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $36.31 / $89.13
| Professional | TC | $28.84 | $36.31 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $83.18 / $169.82
| Professional | | $63.10 | $83.18 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $52.48 / $97.72
| Professional | 26 | $37.15 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $33.11 / $70.79
| Professional | TC | $22.39 | $33.11 | $70.79 |