- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $147.91 / $467.74
| Professional | | $107.15 | $147.91 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $33.88 / $97.72
| Professional | 26 | $22.91 | $33.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.28 / $102.33 / $186.21
| Professional | TC | $81.28 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $162.18 / $363.08
| Professional | | $134.90 | $162.18 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $44.67 / $89.13
| Professional | 26 | $44.67 | $44.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $100.00 / $100.00 / $117.49
| Professional | TC | $100.00 | $100.00 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $363.08
| Professional | | $102.33 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $51.29 / $89.13
| Professional | 26 | $23.99 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.43 / $151.36 / $223.87
| Professional | TC | $79.43 | $151.36 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $363.08
| Professional | | $102.33 | $102.33 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $26.92 / $89.13
| Professional | 26 | $25.12 | $26.92 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.13 / $77.62 / $154.88
| Professional | TC | $74.13 | $77.62 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $141.25 / $251.19
| Professional | | $100.00 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $36.31 / $58.88
| Professional | 26 | $26.30 | $36.31 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.13 / $104.71 / $173.78
| Professional | TC | $74.13 | $104.71 | $173.78 |