- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.15 / $46.22 / $60.38
| Professional | | $41.15 | $46.22 | $60.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.24 / $13.17 / $27.56
| Professional | 26 | $11.24 | $13.17 | $27.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.92 / $33.28 / $56.43
| Professional | TC | $29.92 | $33.28 | $56.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.53 / $63.00 / $81.93
| Professional | | $43.53 | $63.00 | $81.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.18 / $18.07 / $23.91
| Professional | 26 | $12.18 | $18.07 | $23.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.58 / $45.00 / $58.01
| Professional | TC | $31.58 | $45.00 | $58.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.53 / $76.26 / $87.34
| Professional | | $51.53 | $76.26 | $87.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.36 / $19.80 / $22.64
| Professional | 26 | $13.36 | $19.80 | $22.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.17 / $56.61 / $64.70
| Professional | TC | $38.17 | $56.61 | $64.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.09 / $32.34 / $70.23
| Professional | | $19.09 | $32.34 | $70.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $270.73 / $270.73 / $270.73
| Facility | 26 | $270.73 | $270.73 | $270.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.67 / $66.67 / $70.13
| Professional | | $56.67 | $66.67 | $70.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.80 / $17.41 / $19.97
| Professional | 26 | $14.80 | $17.41 | $19.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.86 / $49.25 / $50.16
| Professional | TC | $41.86 | $49.25 | $50.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.27 / $57.81 / $78.72
| Professional | | $43.27 | $57.81 | $78.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.82 / $16.93 / $22.70
| Professional | 26 | $12.82 | $16.93 | $22.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.92 / $42.00 / $56.32
| Professional | TC | $31.92 | $42.00 | $56.32 |