- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.96 / $233.65 / $689.76
| Facility | | $39.96 | $233.65 | $689.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.71 / $7.71 / $7.85
| Facility | 26 | $7.71 | $7.71 | $7.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $245.74 / $333.45 / $626.14
| Facility | TC | $245.74 | $333.45 | $626.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.92 / $28.39 / $61.75
| Professional | | $7.92 | $28.39 | $61.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.47 / $9.09 / $41.00
| Professional | 26 | $6.47 | $9.09 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $30.24 / $38.74 / $38.74
| Professional | 50 | $30.24 | $38.74 | $38.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.98 / $14.20 / $20.62
| Professional | 52 | $12.98 | $14.20 | $20.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.48 / $21.55 / $185.22
| Professional | TC | $19.48 | $21.55 | $185.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.00 / $145.00 / $145.00
| Professional | | $87.00 | $145.00 | $145.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.00 / $34.00 / $34.00
| Professional | 26 | $20.00 | $34.00 | $34.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.00 / $111.00 / $111.00
| Professional | TC | $67.00 | $111.00 | $111.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.59 / $44.55 / $81.53
| Professional | | $30.59 | $44.55 | $81.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $12.64 / $22.21
| Professional | 26 | $8.86 | $12.64 | $22.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.28 / $30.49 / $57.28
| Professional | TC | $21.28 | $30.49 | $57.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.94 / $57.04 / $99.60
| Professional | | $31.94 | $57.04 | $99.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.17 / $14.88 / $26.40
| Professional | 26 | $8.17 | $14.88 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $42.16 / $73.62
| Professional | TC | $23.44 | $42.16 | $73.62 |