- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.25 / $103.91 / $428.35
| Facility | | $37.25 | $103.91 | $428.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.03 / $13.83 / $17.97
| Facility | 26 | $11.03 | $13.83 | $17.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.46 / $38.07 / $61.86
| Professional | | $27.46 | $38.07 | $61.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.98 / $12.56 / $20.66
| Professional | 26 | $8.98 | $12.56 | $20.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.76 / $25.61 / $44.93
| Professional | TC | $19.76 | $25.61 | $44.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.05 / $33.86 / $33.86
| Professional | | $25.05 | $33.86 | $33.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $11.23 / $24.41
| Professional | 26 | $10.00 | $11.23 | $24.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.10 / $94.61 / $182.65
| Facility | | $48.10 | $94.61 | $182.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.83 / $47.02 / $57.39
| Professional | | $41.83 | $47.02 | $57.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.35 / $15.70 / $20.07
| Professional | 26 | $12.35 | $15.70 | $20.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.66 / $32.84 / $39.29
| Professional | TC | $28.66 | $32.84 | $39.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.02 / $33.90 / $61.81
| Facility | | $32.02 | $33.90 | $61.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.76 / $10.22 / $18.53
| Professional | 26 | $9.76 | $10.22 | $18.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.22 / $52.26 / $97.83
| Facility | | $33.22 | $52.26 | $97.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.45 / $34.86 / $63.77
| Professional | | $21.45 | $34.86 | $63.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.65 / $12.00 / $20.00
| Professional | 26 | $6.65 | $12.00 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.80 / $24.66 / $42.50
| Professional | TC | $14.80 | $24.66 | $42.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.81 / $36.09 / $57.64
| Professional | | $25.81 | $36.09 | $57.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.94 / $11.90 / $18.10
| Professional | 26 | $8.94 | $11.90 | $18.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.82 / $24.54 / $39.77
| Professional | TC | $16.82 | $24.54 | $39.77 |