- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.21 / $278.63 / $937.93
| Facility | | $152.21 | $278.63 | $937.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.87 / $69.87 / $127.91
| Facility | 26 | $69.87 | $69.87 | $127.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.22 / $106.32 / $106.32
| Professional | | $96.22 | $106.32 | $106.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.93 / $40.96 / $379.59
| Professional | 26 | $39.93 | $40.96 | $379.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.28 / $65.36 / $65.36
| Professional | TC | $56.28 | $65.36 | $65.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.47 / $119.47 / $216.26
| Professional | | $119.47 | $119.47 | $216.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.92 / $39.88 / $65.44
| Professional | 26 | $27.92 | $39.88 | $65.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.71 / $67.65 / $79.59
| Professional | TC | $55.71 | $67.65 | $79.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.37 / $147.37 / $147.37
| Facility | | $147.37 | $147.37 | $147.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.77 / $168.03 / $209.50
| Professional | | $63.77 | $168.03 | $209.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.35 / $65.68 / $75.80
| Professional | 26 | $21.35 | $65.68 | $75.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.42 / $99.82 / $143.00
| Professional | TC | $42.42 | $99.82 | $143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.02 / $132.83 / $212.53
| Professional | | $50.02 | $132.83 | $212.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.46 / $52.85 / $87.98
| Professional | 26 | $28.46 | $52.85 | $87.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.56 / $97.08 / $132.28
| Professional | TC | $21.56 | $97.08 | $132.28 |