- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.48 / $344.08 / $982.56
| Facility | | $86.48 | $344.08 | $982.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.98 / $28.98 / $34.09
| Facility | 26 | $28.98 | $28.98 | $34.09 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $57.50 / $57.50 / $78.73
| Facility | TC | $57.50 | $57.50 | $78.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.54 / $86.49 / $112.82
| Professional | | $71.54 | $86.49 | $112.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.69 / $28.99 / $34.85
| Professional | 26 | $21.69 | $28.99 | $34.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.84 / $56.09 / $73.33
| Professional | TC | $49.84 | $56.09 | $73.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.02 / $69.18 / $217.48
| Professional | | $49.02 | $69.18 | $217.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.59 / $23.37 / $114.01
| Professional | 26 | $20.59 | $23.37 | $114.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.43 / $45.81 / $103.47
| Professional | TC | $28.43 | $45.81 | $103.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.69 / $95.69 / $95.69
| Professional | | $95.69 | $95.69 | $95.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.36 / $29.36 / $29.65
| Professional | 26 | $29.36 | $29.36 | $29.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $63.08 / $63.08 / $63.08
| Professional | TC | $63.08 | $63.08 | $63.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.12 / $102.39 / $239.93
| Professional | | $56.12 | $102.39 | $239.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.37 / $35.35 / $81.86
| Professional | 26 | $24.37 | $35.35 | $81.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.56 / $56.30 / $158.07
| Professional | TC | $41.56 | $56.30 | $158.07 |