- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $323.59 / $691.83
| Facility | | $19.95 | $323.59 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $8.32 / $8.32
| Facility | 26 | $8.32 | $8.32 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $295.12 / $371.54 / $549.54
| Facility | TC | $295.12 | $371.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $33.11 / $64.57
| Professional | | $24.55 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $13.49 / $20.89
| Professional | 26 | $7.08 | $13.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $22.91 / $38.90
| Professional | TC | $17.78 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $112.20 / $112.20
| Professional | | $72.44 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $33.11 / $33.11
| Professional | 26 | $20.89 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.29 / $77.62 / $77.62
| Professional | TC | $51.29 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $44.67 / $81.28
| Professional | | $26.30 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $14.45 / $26.30
| Professional | 26 | $9.12 | $14.45 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.60 / $31.62 / $56.23
| Professional | TC | $16.60 | $31.62 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $50.12 / $87.10
| Professional | | $27.54 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $15.85 / $27.54
| Professional | 26 | $9.12 | $15.85 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $34.67 / $58.88
| Professional | TC | $18.20 | $34.67 | $58.88 |