- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.98 / $160.08 / $421.44
| Facility | | $19.98 | $160.08 | $421.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.30 / $10.30 / $10.51
| Facility | 26 | $10.30 | $10.30 | $10.51 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $225.30 / $245.74 / $430.64
| Facility | TC | $225.30 | $245.74 | $430.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.82 / $35.10 / $47.34
| Professional | | $29.82 | $35.10 | $47.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.61 / $12.21 / $25.52
| Professional | 26 | $8.61 | $12.21 | $25.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.21 / $25.05 / $56.55
| Professional | TC | $21.21 | $25.05 | $56.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.00 / $167.00 / $167.00
| Professional | | $101.00 | $167.00 | $167.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.00 / $45.00 / $45.00
| Professional | 26 | $27.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.00 / $122.00 / $122.00
| Professional | TC | $74.00 | $122.00 | $122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.94 / $53.84 / $93.76
| Professional | | $36.94 | $53.84 | $93.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.85 / $16.89 / $31.80
| Professional | 26 | $11.85 | $16.89 | $31.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.52 / $35.13 / $61.73
| Professional | TC | $24.52 | $35.13 | $61.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.40 / $67.42 / $115.86
| Professional | | $39.40 | $67.42 | $115.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.89 / $21.64 / $35.20
| Professional | 26 | $11.89 | $21.64 | $35.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.52 / $47.54 / $81.20
| Professional | TC | $27.52 | $47.54 | $81.20 |