- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.92 / $78.55 / $141.50
| Professional | | $66.92 | $78.55 | $141.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.77 / $52.77 / $215.00
| Professional | 26 | $42.77 | $52.77 | $215.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.15 / $27.65 / $79.00
| Professional | TC | $24.15 | $27.65 | $79.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.19 / $94.19 / $312.11
| Professional | | $94.19 | $94.19 | $312.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.32 / $136.38 / $312.11
| Professional | | $87.32 | $136.38 | $312.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.48 / $84.39 / $150.43
| Professional | 26 | $55.48 | $84.39 | $150.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.53 / $50.45 / $93.54
| Professional | TC | $28.53 | $50.45 | $93.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.68 / $125.97 / $183.08
| Professional | | $79.68 | $125.97 | $183.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.04 / $82.18 / $150.43
| Professional | 26 | $54.04 | $82.18 | $150.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.53 / $44.10 / $76.69
| Professional | TC | $28.53 | $44.10 | $76.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.41 / $110.08 / $317.77
| Professional | | $79.41 | $110.08 | $317.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.24 / $72.26 / $177.73
| Professional | 26 | $45.24 | $72.26 | $177.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.17 / $48.17 / $140.05
| Professional | TC | $34.17 | $48.17 | $140.05 |