- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.77 / $544.12 / $554.83
| Facility | | $41.77 | $544.12 | $554.83 |
- 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
- $31.26 / $544.12 / $554.83
| Facility | TC | $31.26 | $544.12 | $554.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.05 / $35.95 / $49.46
| Professional | | $31.05 | $35.95 | $49.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.61 / $11.45 / $26.02
| Professional | 26 | $8.61 | $11.45 | $26.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.44 / $25.57 / $37.25
| Professional | TC | $22.44 | $25.57 | $37.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.00 / $174.00 / $174.00
| Professional | | $106.00 | $174.00 | $174.00 |
- 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
- $79.00 / $129.00 / $129.00
| Professional | TC | $79.00 | $129.00 | $129.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.85 / $59.49 / $102.17
| Professional | | $40.85 | $59.49 | $102.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.85 / $16.89 / $30.46
| Professional | 26 | $11.85 | $16.89 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.11 / $40.36 / $71.70
| Professional | TC | $28.11 | $40.36 | $71.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.71 / $74.23 / $122.10
| Professional | | $37.71 | $74.23 | $122.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.21 / $20.28 / $36.29
| Professional | 26 | $11.21 | $20.28 | $36.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.50 / $50.70 / $85.79
| Professional | TC | $26.50 | $50.70 | $85.79 |