- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.47 / $53.84 / $524.76
| Facility | | $41.47 | $53.84 | $524.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $14.01 / $26.65
| Facility | 26 | $10.36 | $14.01 | $26.65 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $29.89 / $39.84 / $349.08
| Facility | TC | $29.89 | $39.84 | $349.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.95 / $35.95 / $48.73
| Professional | | $35.95 | $35.95 | $48.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.65 / $10.36 / $16.66
| Professional | 26 | $9.65 | $10.36 | $16.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.57 / $26.30 / $36.17
| Professional | TC | $25.57 | $26.30 | $36.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.48 / $193.48 / $193.48
| Facility | | $193.48 | $193.48 | $193.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $44.16 / $73.42
| Professional | | $28.59 | $44.16 | $73.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.83 / $12.96 / $19.32
| Professional | 26 | $7.83 | $12.96 | $19.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.52 / $31.20 / $53.85
| Professional | TC | $21.52 | $31.20 | $53.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.39 / $58.84 / $293.24
| Facility | | $57.39 | $58.84 | $293.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.78 / $37.78 / $48.58
| Professional | | $37.78 | $37.78 | $48.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.75 / $13.50 / $214.88
| Professional | 26 | $9.75 | $13.50 | $214.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.85 / $44.46 / $89.01
| Professional | | $31.85 | $44.46 | $89.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $11.67 / $25.67
| Professional | 26 | $7.95 | $11.67 | $25.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.58 / $32.46 / $64.86
| Professional | TC | $23.58 | $32.46 | $64.86 |