- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.47 / $67.84 / $273.00
| Professional | | $45.47 | $67.84 | $273.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.37 / $16.04 / $58.00
| Professional | 26 | $10.37 | $16.04 | $58.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.17 / $50.35 / $72.20
| Professional | TC | $48.17 | $50.35 | $72.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.45 / $93.65 / $141.41
| Professional | | $79.45 | $93.65 | $141.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.36 / $26.12 / $36.65
| Professional | 26 | $25.36 | $26.12 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.94 / $66.94 / $71.50
| Professional | TC | $66.94 | $66.94 | $71.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.75 / $70.14 / $161.15
| Professional | | $48.75 | $70.14 | $161.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.01 / $17.88 / $36.65
| Professional | 26 | $12.01 | $17.88 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.39 / $52.55 / $119.79
| Professional | TC | $35.39 | $52.55 | $119.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.80 / $84.34 / $159.27
| Professional | | $55.80 | $84.34 | $159.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.25 / $18.39 / $36.65
| Professional | 26 | $14.25 | $18.39 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.55 / $58.10 / $112.28
| Professional | TC | $41.55 | $58.10 | $112.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.26 / $84.29 / $96.94
| Professional | | $57.26 | $84.29 | $96.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.69 / $19.87 / $45.00
| Professional | 26 | $12.69 | $19.87 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.57 / $62.58 / $128.57
| Professional | TC | $44.57 | $62.58 | $128.57 |