- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.83 / $36.38 / $443.52
| Facility | | $34.83 | $36.38 | $443.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.36 / $8.36 / $8.52
| Facility | 26 | $8.36 | $8.36 | $8.52 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.47 / $26.47 / $27.86
| Facility | TC | $26.47 | $26.47 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.97 / $33.50 / $42.89
| Professional | | $26.97 | $33.50 | $42.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.99 / $9.89 / $11.89
| Professional | 26 | $6.99 | $9.89 | $11.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.98 / $22.87 / $33.00
| Professional | TC | $19.98 | $22.87 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.00 / $151.00 / $151.00
| Professional | | $92.00 | $151.00 | $151.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.00 / $36.00 / $36.00
| Professional | 26 | $22.00 | $36.00 | $36.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $70.00 / $115.00 / $115.00
| Professional | TC | $70.00 | $115.00 | $115.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.52 / $51.94 / $100.55
| Professional | | $35.52 | $51.94 | $100.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.41 / $17.34 / $33.21
| Professional | 26 | $11.41 | $17.34 | $33.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.72 / $33.10 / $64.29
| Professional | TC | $22.72 | $33.10 | $64.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.36 / $63.38 / $108.27
| Professional | | $37.36 | $63.38 | $108.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.23 / $18.39 / $36.31
| Professional | 26 | $12.23 | $18.39 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.14 / $44.72 / $76.86
| Professional | TC | $25.14 | $44.72 | $76.86 |