- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.76 / $105.45 / $305.89
| Facility | | $50.76 | $105.45 | $305.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.36 / $8.36 / $8.52
| Facility | 26 | $8.36 | $8.36 | $8.52 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.15 / $225.30 / $372.40
| Facility | TC | $26.15 | $225.30 | $372.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.48 / $29.42 / $42.46
| Professional | | $26.48 | $29.42 | $42.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.99 / $8.46 / $42.23
| Professional | 26 | $6.99 | $8.46 | $42.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.48 / $21.55 / $32.57
| Professional | TC | $19.48 | $21.55 | $32.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.00 / $150.00 / $150.00
| Professional | | $91.00 | $150.00 | $150.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.00 / $36.00 / $36.00
| Professional | 26 | $22.00 | $36.00 | $36.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.00 / $114.00 / $114.00
| Professional | TC | $69.00 | $114.00 | $114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.50 / $48.78 / $83.84
| Professional | | $33.50 | $48.78 | $83.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.61 / $13.71 / $24.96
| Professional | 26 | $9.61 | $13.71 | $24.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.08 / $33.10 / $58.87
| Professional | TC | $23.08 | $33.10 | $58.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.92 / $61.48 / $100.10
| Professional | | $30.92 | $61.48 | $100.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.17 / $16.47 / $29.69
| Professional | 26 | $9.17 | $16.47 | $29.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.75 / $45.01 / $70.41
| Professional | TC | $21.75 | $45.01 | $70.41 |