- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.91 / $57.85 / $244.02
| Facility | | $4.91 | $57.85 | $244.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.19 / $8.94 / $51.09
| Facility | 26 | $6.19 | $8.94 | $51.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.81 / $9.50 / $14.59
| Professional | | $8.81 | $9.50 | $14.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.12 / $6.45 / $9.71
| Professional | 26 | $6.12 | $6.45 | $9.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.69 / $2.99 / $4.58
| Professional | TC | $2.69 | $2.99 | $4.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.27 / $19.17 / $27.77
| Facility | | $14.27 | $19.17 | $27.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $10.85 / $14.90
| Professional | | $9.63 | $10.85 | $14.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.66 / $3.66 / $31.45
| Facility | | $3.66 | $3.66 | $31.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.08 / $8.08 / $13.76
| Facility | 26 | $8.08 | $8.08 | $13.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $11.50 / $17.73
| Professional | | $9.72 | $11.50 | $17.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.74 / $8.36 / $12.77
| Professional | 26 | $6.74 | $8.36 | $12.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.84 / $3.41 / $5.94
| Professional | TC | $2.84 | $3.41 | $5.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.01 / $15.42 / $40.65
| Facility | | $9.01 | $15.42 | $40.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.60 / $100.00 / $100.00
| Facility | 26 | $17.60 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $14.23 / $1,428.44
| Professional | | $11.04 | $14.23 | $1,428.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.22 / $9.59 / $1,274.28
| Professional | 26 | $7.22 | $9.59 | $1,274.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.45 / $4.37 / $988.10
| Professional | TC | $3.45 | $4.37 | $988.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.80 / $38.72 / $61.26
| Facility | | $10.80 | $38.72 | $61.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $13.34 / $18.41
| Professional | | $10.43 | $13.34 | $18.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.22 / $9.59 / $12.69
| Professional | 26 | $7.22 | $9.59 | $12.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.45 / $3.97 / $5.94
| Professional | TC | $3.45 | $3.97 | $5.94 |