- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.30 / $99.27 / $380.10
| Facility | | $45.30 | $99.27 | $380.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $12.28 / $26.65
| Facility | 26 | $10.36 | $12.28 | $26.65 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $28.26 / $72.62 / $399.00
| Facility | TC | $28.26 | $72.62 | $399.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.51 / $38.63 / $89.69
| Professional | | $34.51 | $38.63 | $89.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.65 / $10.37 / $29.88
| Professional | 26 | $9.65 | $10.37 | $29.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.86 / $28.26 / $38.04
| Professional | TC | $24.86 | $28.26 | $38.04 |
- 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
- $27.09 / $37.86 / $70.45
| Professional | | $27.09 | $37.86 | $70.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.62 / $12.27 / $19.32
| Professional | 26 | $7.62 | $12.27 | $19.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.73 / $27.29 / $50.89
| Professional | TC | $17.73 | $27.29 | $50.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.48 / $176.84 / $434.49
| Facility | | $56.48 | $176.84 | $434.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $365.00 / $365.00 / $434.40
| Facility | TC | $365.00 | $365.00 | $434.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $36.26 / $36.26
| Professional | | $36.26 | $36.26 | $36.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.86 / $13.50 / $107.44
| Professional | 26 | $9.86 | $13.50 | $107.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $41.17 / $85.03
| Professional | | $30.90 | $41.17 | $85.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.81 / $12.30 / $25.24
| Professional | 26 | $8.81 | $12.30 | $25.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.34 / $23.77 / $59.79
| Professional | TC | $21.34 | $23.77 | $59.79 |