- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $389.05 / $616.60
| Facility | | $51.29 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $9.55 / $9.55
| Facility | 26 | $8.32 | $9.55 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $331.13 / $426.58
| Facility | TC | $223.87 | $331.13 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $33.11 / $69.18
| Professional | | $8.13 | $33.11 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $15.85 / $36.31
| Professional | 26 | $7.94 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $45.71 / $61.66
| Professional | TC | $21.88 | $45.71 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $128.82
| Professional | | $83.18 | $128.82 | $128.82 |
- 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
- $63.10 / $97.72 / $97.72
| Professional | TC | $63.10 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $52.48 / $93.33
| Professional | | $33.88 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $14.13 / $26.30
| Professional | 26 | $9.12 | $14.13 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $38.90 / $70.79
| Professional | TC | $24.55 | $38.90 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $54.95 / $102.33
| Professional | | $34.67 | $54.95 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $15.85 / $26.92
| Professional | 26 | $8.51 | $15.85 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $38.90 / $74.13
| Professional | TC | $25.70 | $38.90 | $74.13 |