- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $30.90 / $371.54
| Professional | | $17.78 | $30.90 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.77 / $23.44
| Professional | 26 | $7.08 | $9.77 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.23 / $19.05 / $74.13
| Professional | TC | $10.23 | $19.05 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | 26 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $37.15 / $102.33
| Professional | | $31.62 | $37.15 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $14.13 / $39.81
| Professional | 26 | $12.02 | $14.13 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $17.78 / $21.38
| Professional | TC | $17.78 | $17.78 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $75.86 / $177.83
| Professional | | $31.62 | $75.86 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $14.79 / $29.51
| Professional | 26 | $13.18 | $14.79 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $47.86 / $154.88
| Professional | TC | $18.20 | $47.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $28.84 / $102.33
| Professional | | $28.84 | $28.84 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $10.00 / $39.81
| Professional | 26 | $10.00 | $10.00 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Professional | TC | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $52.48 / $162.18
| Professional | | $22.39 | $52.48 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $13.80 / $32.36
| Professional | 26 | $9.77 | $13.80 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $32.36 / $151.36
| Professional | TC | $12.88 | $32.36 | $151.36 |