- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $89.13 / $331.13
| Facility | | $37.15 | $89.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $10.00 / $21.88
| Facility | 26 | $8.32 | $10.00 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $36.31 / $575.44
| Facility | TC | $26.30 | $36.31 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $39.81 / $144.54
| Professional | | $30.20 | $39.81 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $16.60 / $44.67
| Professional | 26 | $7.94 | $16.60 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $25.70 / $66.07
| Professional | TC | $20.89 | $25.70 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $40.74 / $64.57
| Professional | | $24.55 | $40.74 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.31 / $13.18 / $19.95
| Professional | 26 | $6.31 | $13.18 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $28.18 / $46.77
| Professional | TC | $16.98 | $28.18 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $64.57 / $239.88
| Facility | | $51.29 | $64.57 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | TC | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $8.13 / $77.62
| Professional | 26 | $7.94 | $8.13 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $38.90 / $79.43
| Professional | | $28.84 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $11.22 / $22.91
| Professional | 26 | $8.32 | $11.22 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $26.92 / $56.23
| Professional | TC | $19.95 | $26.92 | $56.23 |