- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.27 / $184.10 / $502.71
| Facility | | $44.27 | $184.10 | $502.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.78 / $10.50 / $39.18
| Facility | 26 | $7.78 | $10.50 | $39.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.01 / $65.86 / $310.00
| Facility | TC | $26.01 | $65.86 | $310.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.41 / $33.40 / $76.34
| Professional | | $27.41 | $33.40 | $76.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.23 / $7.95 / $23.01
| Professional | 26 | $7.23 | $7.95 | $23.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $333.20 / $368.20 / $574.00
| Professional | 50 | $333.20 | $368.20 | $574.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.05 / $16.70 / $17.28
| Professional | 52 | $14.05 | $16.70 | $17.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.46 / $22.54 / $39.96
| Professional | TC | $19.46 | $22.54 | $39.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.77 / $137.77 / $137.77
| Facility | | $137.77 | $137.77 | $137.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.80 / $32.33 / $60.79
| Professional | | $24.80 | $32.33 | $60.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.81 / $9.71 / $14.48
| Professional | 26 | $5.81 | $9.71 | $14.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.75 / $22.99 / $46.15
| Professional | TC | $14.75 | $22.99 | $46.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.65 / $201.03 / $361.05
| Facility | | $47.65 | $201.03 | $361.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $263.00 / $263.00 / $263.00
| Facility | TC | $263.00 | $263.00 | $263.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.38 / $31.38 / $31.38
| Professional | | $31.38 | $31.38 | $31.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.40 / $10.40 / $20.23
| Professional | 26 | $7.40 | $10.40 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.82 / $32.82 / $74.73
| Professional | | $25.82 | $32.82 | $74.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.86 / $9.86 / $19.27
| Professional | 26 | $5.86 | $9.86 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.30 / $25.79 / $55.78
| Professional | TC | $18.30 | $25.79 | $55.78 |