- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.38 / $190.40 / $419.55
| Professional | | $131.38 | $190.40 | $419.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.63 / $20.83 / $32.35
| Professional | 26 | $20.63 | $20.83 | $32.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $106.73 / $169.58 / $195.01
| Professional | TC | $106.73 | $169.58 | $195.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.40 / $174.89 / $229.86
| Professional | | $108.40 | $174.89 | $229.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.91 / $25.22 / $43.59
| Professional | 26 | $19.91 | $25.22 | $43.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $95.91 / $153.21 / $188.66
| Professional | TC | $95.91 | $153.21 | $188.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.66 / $185.26 / $325.82
| Professional | | $111.66 | $185.26 | $325.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.73 / $23.93 / $57.79
| Professional | 26 | $16.73 | $23.93 | $57.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $100.71 / $161.54 / $261.87
| Professional | TC | $100.71 | $161.54 | $261.87 |