- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.62 / $8.38 / $18.79
| Facility | 26 | $7.62 | $8.38 | $18.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $37.67 / $183.95 / $455.69
| Facility | TC | $37.67 | $183.95 | $455.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.41 / $46.81 / $141.99
| Professional | | $28.41 | $46.81 | $141.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.83 / $8.99 / $28.70
| Professional | 26 | $5.83 | $8.99 | $28.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.00 / $141.00 / $141.00
| Professional | 50 | $141.00 | $141.00 | $141.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.24 / $22.65 / $45.29
| Professional | 52 | $12.24 | $22.65 | $45.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.57 / $37.67 / $67.31
| Professional | TC | $22.57 | $37.67 | $67.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.34 / $71.79 / $99.09
| Professional | | $63.34 | $71.79 | $99.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.03 / $10.74 / $11.60
| Professional | 26 | $7.03 | $10.74 | $11.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.85 / $58.98 / $69.13
| Professional | TC | $39.85 | $58.98 | $69.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $100.00 / $143.82 / $143.82
| Facility | TC | $100.00 | $143.82 | $143.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.10 / $90.12 / $333.90
| Professional | | $49.10 | $90.12 | $333.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.24 / $16.05 / $56.18
| Professional | 26 | $9.24 | $16.05 | $56.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $49.66 / $73.65 / $112.20
| Professional | 50 | $49.66 | $73.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $23.96 / $23.96 / $23.96
| Professional | 52 | $23.96 | $23.96 | $23.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.71 / $72.93 / $277.80
| Professional | TC | $38.71 | $72.93 | $277.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.84 / $60.47 / $125.51
| Professional | | $31.84 | $60.47 | $125.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.94 / $12.08 / $20.26
| Professional | 26 | $6.94 | $12.08 | $20.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.00 / $49.92 / $103.92
| Professional | TC | $25.00 | $49.92 | $103.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.75 / $15.16 / $236.39
| Facility | 26 | $7.75 | $15.16 | $236.39 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.04 / $52.56 / $236.39
| Facility | TC | $26.04 | $52.56 | $236.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.24 / $62.64 / $102.33
| Professional | | $32.24 | $62.64 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.12 / $14.40 / $18.82
| Professional | 26 | $7.12 | $14.40 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.69 / $50.22 / $84.63
| Professional | TC | $25.69 | $50.22 | $84.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.15 / $54.50 / $92.81
| Professional | | $9.15 | $54.50 | $92.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.80 / $13.10 / $13.40
| Facility | 26 | $9.80 | $13.10 | $13.40 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $35.77 / $53.60 / $63.65
| Facility | TC | $35.77 | $53.60 | $63.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.03 / $11.50 / $13.80
| Professional | 26 | $8.03 | $11.50 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.15 / $42.75 / $53.60
| Professional | TC | $30.15 | $42.75 | $53.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.06 / $9.06 / $9.14
| Facility | 26 | $9.06 | $9.06 | $9.14 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $41.68 / $41.68 / $43.42
| Facility | TC | $41.68 | $41.68 | $43.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.16 / $87.66 / $107.79
| Professional | | $58.16 | $87.66 | $107.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.31 / $15.48 / $18.75
| Professional | 26 | $10.31 | $15.48 | $18.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.24 / $72.42 / $89.04
| Professional | TC | $46.24 | $72.42 | $89.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $156.94 / $156.94 / $209.36
| Facility | 26 | $156.94 | $156.94 | $209.36 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $156.94 / $156.94 / $209.36
| Facility | TC | $156.94 | $156.94 | $209.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.74 / $78.16 / $103.29
| Professional | | $51.74 | $78.16 | $103.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.60 / $13.76 / $18.68
| Professional | 26 | $9.60 | $13.76 | $18.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.50 / $64.20 / $86.64
| Professional | TC | $42.50 | $64.20 | $86.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.51 / $42.49 / $98.83
| Professional | | $31.51 | $42.49 | $98.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.85 / $7.90 / $19.01
| Professional | 26 | $6.85 | $7.90 | $19.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.35 / $35.03 / $85.69
| Professional | TC | $24.35 | $35.03 | $85.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.40 / $44.40 / $44.40
| Professional | | $44.40 | $44.40 | $44.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.03 / $7.03 / $7.03
| Professional | 26 | $7.03 | $7.03 | $7.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.36 / $37.36 / $37.36
| Professional | TC | $37.36 | $37.36 | $37.36 |