- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.80 / $218.80 / $400.53
| Facility | | $218.80 | $218.80 | $400.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.38 / $50.38 / $92.22
| Facility | 26 | $50.38 | $50.38 | $92.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.32 / $92.10 / $92.10
| Professional | | $90.32 | $92.10 | $92.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.65 / $29.65 / $30.49
| Professional | 26 | $29.65 | $29.65 | $30.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $59.82 / $62.45 / $62.45
| Professional | TC | $59.82 | $62.45 | $62.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.28 / $173.28 / $199.10
| Professional | | $173.28 | $173.28 | $199.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.06 / $37.22 / $51.87
| Professional | 26 | $26.06 | $37.22 | $51.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $95.24 / $115.64 / $136.05
| Professional | TC | $95.24 | $115.64 | $136.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.93 / $232.93 / $232.93
| Facility | | $232.93 | $232.93 | $232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.06 / $176.18 / $305.95
| Professional | | $66.06 | $176.18 | $305.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.57 / $53.98 / $66.14
| Professional | 26 | $19.57 | $53.98 | $66.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.43 / $119.36 / $244.47
| Professional | TC | $43.43 | $119.36 | $244.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.07 / $183.25 / $271.76
| Professional | | $62.07 | $183.25 | $271.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.61 / $41.31 / $64.02
| Professional | 26 | $19.61 | $41.31 | $64.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.95 / $141.94 / $209.11
| Professional | TC | $37.95 | $141.94 | $209.11 |