- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.55 / $272.64 / $448.94
| Facility | | $71.55 | $272.64 | $448.94 |
- 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
- $223.35 / $275.29 / $430.64
| Facility | TC | $223.35 | $275.29 | $430.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.63 / $38.57 / $78.84
| Professional | | $10.63 | $38.57 | $78.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.11 / $12.21 / $53.53
| Professional | 26 | $9.11 | $12.21 | $53.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.64 / $29.46 / $74.64
| Professional | TC | $26.64 | $29.46 | $74.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $198.00 / $198.00
| Professional | | $120.00 | $198.00 | $198.00 |
- 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
- $93.00 / $153.00 / $153.00
| Professional | TC | $93.00 | $153.00 | $153.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.65 / $62.07 / $106.75
| Professional | | $42.65 | $62.07 | $106.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.85 / $16.89 / $29.54
| Professional | 26 | $11.85 | $16.89 | $29.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.27 / $43.47 / $78.80
| Professional | TC | $30.27 | $43.47 | $78.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.40 / $80.00 / $127.59
| Professional | | $39.40 | $80.00 | $127.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.87 / $21.64 / $35.20
| Professional | 26 | $10.87 | $21.64 | $35.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.54 / $60.20 / $102.84
| Professional | TC | $28.54 | $60.20 | $102.84 |