- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.53 / $376.90 / $656.63
| Facility | | $37.53 | $376.90 | $656.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.39 / $7.39 / $7.53
| Facility | 26 | $7.39 | $7.39 | $7.53 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $24.79 / $245.74 / $430.64
| Facility | TC | $24.79 | $245.74 | $430.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.94 / $26.46 / $38.75
| Professional | | $23.94 | $26.46 | $38.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.19 / $8.02 / $12.46
| Professional | 26 | $6.19 | $8.02 | $12.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.75 / $19.64 / $47.29
| Professional | TC | $17.75 | $19.64 | $47.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.00 / $136.00 / $136.00
| Professional | | $82.00 | $136.00 | $136.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.00 / $34.00 / $34.00
| Professional | 26 | $20.00 | $34.00 | $34.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $62.00 / $102.00 / $102.00
| Professional | TC | $62.00 | $102.00 | $102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $42.00 / $75.73
| Professional | | $28.84 | $42.00 | $75.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.59 / $12.40 / $23.13
| Professional | 26 | $8.59 | $12.40 | $23.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.12 / $27.39 / $51.76
| Professional | TC | $19.12 | $27.39 | $51.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.56 / $54.56 / $95.28
| Professional | | $29.56 | $54.56 | $95.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.83 / $15.21 / $26.40
| Professional | 26 | $8.83 | $15.21 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.73 / $39.68 / $58.29
| Professional | TC | $20.73 | $39.68 | $58.29 |