- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.98 / $387.00 / $1,243.58
| Facility | | $19.98 | $387.00 | $1,243.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $9.33 / $9.51
| Facility | 26 | $9.33 | $9.33 | $9.51 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $302.48 / $544.02 / $554.83
| Facility | TC | $302.48 | $544.02 | $554.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.81 / $30.73 / $38.95
| Professional | | $24.81 | $30.73 | $38.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.80 / $9.73 / $18.25
| Professional | 26 | $7.80 | $9.73 | $18.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.01 / $21.01 / $27.90
| Professional | TC | $17.01 | $21.01 | $27.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $139.00 / $139.00
| Professional | | $85.00 | $139.00 | $139.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.00 / $41.00 / $41.00
| Professional | 26 | $25.00 | $41.00 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.00 / $98.00 / $98.00
| Professional | TC | $60.00 | $98.00 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.29 / $48.65 / $88.76
| Professional | | $33.29 | $48.65 | $88.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.73 / $15.78 / $29.54
| Professional | 26 | $10.73 | $15.78 | $29.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.28 / $30.49 / $55.28
| Professional | TC | $21.28 | $30.49 | $55.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.32 / $56.41 / $97.91
| Professional | | $34.32 | $56.41 | $97.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $18.39 / $34.10
| Professional | 26 | $11.22 | $18.39 | $34.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.10 / $38.02 / $64.95
| Professional | TC | $23.10 | $38.02 | $64.95 |