- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $17.63 / $217.26
| Facility | | $5.25 | $17.63 | $217.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.19 / $12.37 / $15.78
| Facility | 26 | $7.19 | $12.37 | $15.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.36 / $24.32
| Professional | | $9.42 | $14.36 | $24.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.57 / $9.36 / $15.78
| Professional | 26 | $6.57 | $9.36 | $15.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.86 / $4.49 / $6.70
| Professional | TC | $2.86 | $4.49 | $6.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.56 / $42.56 / $42.56
| Facility | | $42.56 | $42.56 | $42.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $21.00 / $21.00
| Professional | | $21.00 | $21.00 | $21.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.29 / $19.01 / $25.15
| Facility | | $4.29 | $19.01 | $25.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $15.58 / $27.28
| Professional | | $9.35 | $15.58 | $27.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.50 / $11.18 / $18.52
| Professional | 26 | $6.50 | $11.18 | $18.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.80 / $4.62 / $8.47
| Professional | TC | $2.80 | $4.62 | $8.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.28 / $32.34 / $32.34
| Professional | | $6.28 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.77 / $44.78 / $72.52
| Facility | | $30.77 | $44.78 | $72.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.18 / $13.38 / $22.15
| Professional | | $10.18 | $13.38 | $22.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.29 / $9.13 / $16.60
| Professional | 26 | $7.29 | $9.13 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.91 / $3.90 / $6.41
| Professional | TC | $2.91 | $3.90 | $6.41 |