- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.79 / $91.50 / $275.55
| Facility | | $36.79 | $91.50 | $275.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $14.01 / $41.88
| Facility | 26 | $10.36 | $14.01 | $41.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.19 / $32.39 / $50.40
| Professional | | $29.19 | $32.39 | $50.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.41 / $9.98 / $16.66
| Professional | 26 | $9.41 | $9.98 | $16.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.76 / $22.54 / $35.92
| Professional | TC | $19.76 | $22.54 | $35.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.77 / $137.77 / $137.77
| Facility | | $137.77 | $137.77 | $137.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.70 / $35.39 / $65.72
| Professional | | $26.70 | $35.39 | $65.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.62 / $11.64 / $19.32
| Professional | 26 | $7.62 | $11.64 | $19.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.49 / $24.88 / $46.15
| Professional | TC | $15.49 | $24.88 | $46.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.49 / $50.93 / $237.40
| Facility | | $49.49 | $50.93 | $237.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.52 / $43.08 / $43.08
| Professional | | $33.52 | $43.08 | $43.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.44 / $13.50 / $94.55
| Professional | 26 | $9.44 | $13.50 | $94.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.19 / $36.72 / $79.45
| Professional | | $28.19 | $36.72 | $79.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.81 / $12.71 / $25.68
| Professional | 26 | $7.81 | $12.71 | $25.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.04 / $27.50 / $55.13
| Professional | TC | $20.04 | $27.50 | $55.13 |