- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.25 / $74.66 / $747.60
| Facility | | $38.25 | $74.66 | $747.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.92 / $17.51 / $33.22
| Facility | 26 | $12.92 | $17.51 | $33.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.91 / $35.92 / $39.40
| Professional | | $30.91 | $35.92 | $39.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.92 / $13.14 / $17.63
| Professional | 26 | $12.92 | $13.14 | $17.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.89 / $22.31 / $26.26
| Professional | TC | $17.89 | $22.31 | $26.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.22 / $37.42 / $71.25
| Professional | | $29.22 | $37.42 | $71.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.67 / $15.54 / $24.08
| Professional | 26 | $9.67 | $15.54 | $24.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.85 / $21.88 / $47.17
| Professional | TC | $17.85 | $21.88 | $47.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.52 / $154.52 / $328.76
| Facility | | $154.52 | $154.52 | $328.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.45 / $35.45 / $35.45
| Professional | | $35.45 | $35.45 | $35.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.47 / $18.02 / $23.40
| Professional | 26 | $12.47 | $18.02 | $23.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.42 / $37.79 / $81.73
| Professional | | $28.42 | $37.79 | $81.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.65 / $16.78 / $32.34
| Professional | 26 | $11.65 | $16.78 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.77 / $22.45 / $49.40
| Professional | TC | $16.77 | $22.45 | $49.40 |