- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $61.66 / $239.88
| Facility | | $13.49 | $61.66 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.47 / $6.31 / $17.78
| Facility | 26 | $3.47 | $6.31 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $18.20 / $47.86
| Professional | | $10.00 | $18.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $6.76 / $20.42
| Professional | 26 | $3.02 | $6.76 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.08 / $11.48 / $28.84
| Professional | TC | $7.08 | $11.48 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.88 / $21.88 / $21.88
| Facility | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $18.62 / $45.71
| Professional | | $10.47 | $18.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $1.86 / $6.61 / $12.59
| Professional | 26 | $1.86 | $6.61 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.31 / $12.30 / $32.36
| Professional | TC | $3.31 | $12.30 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $29.51 / $57.54
| Facility | | $14.45 | $29.51 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1.05 / $5.62 / $8.32
| Facility | 26 | $1.05 | $5.62 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $15.14 / $36.31
| Professional | | $7.59 | $15.14 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.09 / $4.37 / $9.55
| Professional | 26 | $2.09 | $4.37 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.37 / $11.22 / $27.54
| Professional | TC | $5.37 | $11.22 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $7.94 / $13.18
| Facility | | $2.75 | $7.94 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $15.85 / $34.67
| Professional | | $9.12 | $15.85 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.51 / $4.27 / $9.33
| Professional | 26 | $2.51 | $4.27 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.46 / $11.22 / $25.12
| Professional | TC | $6.46 | $11.22 | $25.12 |