- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $223.87 / $512.86
| Facility | | $45.71 | $223.87 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $8.71 / $8.71
| Facility | 26 | $8.71 | $8.71 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $208.93 / $269.15 / $407.38
| Facility | TC | $208.93 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $44.67 / $66.07
| Professional | | $26.30 | $44.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $15.49 / $33.11
| Professional | 26 | $7.94 | $15.49 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $30.90 / $48.98
| Professional | TC | $18.62 | $30.90 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $120.23 / $120.23
| Professional | | $77.62 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $33.88 / $33.88
| Professional | 26 | $21.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.95 / $85.11 / $85.11
| Professional | TC | $54.95 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $47.86 / $77.62
| Professional | | $28.18 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $15.14 / $26.30
| Professional | 26 | $9.55 | $15.14 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $34.67 / $51.29
| Professional | TC | $18.20 | $34.67 | $51.29 |
- 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
- $26.30 / $52.48 / $85.11
| Professional | | $26.30 | $52.48 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $16.60 / $28.84
| Professional | 26 | $8.91 | $16.60 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $35.48 / $56.23
| Professional | TC | $17.38 | $35.48 | $56.23 |