- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.01 / $79.01 / $157.46
| Facility | | $79.01 | $79.01 | $157.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.44 / $11.44 / $24.00
| Facility | 26 | $11.44 | $11.44 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.01 / $100.49 / $215.16
| Professional | | $79.01 | $100.49 | $215.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.44 / $16.05 / $37.72
| Professional | 26 | $11.44 | $16.05 | $37.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.40 / $82.69 / $162.19
| Professional | TC | $67.40 | $82.69 | $162.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.43 / $943.94 / $1,538.14
| Facility | | $257.43 | $943.94 | $1,538.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.82 / $70.40 / $153.96
| Professional | | $13.82 | $70.40 | $153.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.74 / $84.74 / $84.74
| Facility | | $84.74 | $84.74 | $84.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.93 / $112.69 / $160.22
| Professional | | $85.93 | $112.69 | $160.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.56 / $20.90 / $28.98
| Professional | 26 | $13.56 | $20.90 | $28.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $71.30 / $95.03 / $137.16
| Professional | TC | $71.30 | $95.03 | $137.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.95 / $32.34 / $123.65
| Professional | | $18.95 | $32.34 | $123.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.45 / $105.68 / $119.27
| Facility | | $80.45 | $105.68 | $119.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.01 / $140.47 / $236.01
| Professional | | $87.01 | $140.47 | $236.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.57 / $20.90 / $27.42
| Professional | 26 | $13.57 | $20.90 | $27.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.86 / $95.25 / $130.28
| Professional | TC | $69.86 | $95.25 | $130.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.06 / $98.89 / $201.45
| Professional | | $89.06 | $98.89 | $201.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.30 / $17.32 / $36.34
| Professional | 26 | $16.30 | $17.32 | $36.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.76 / $82.29 / $163.79
| Professional | TC | $72.76 | $82.29 | $163.79 |