- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.00 / $42.41 / $81.38
| Facility | | $27.00 | $42.41 | $81.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $4.26 / $5.18 / $6.23
| Facility | 26 | $4.26 | $5.18 | $6.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.63 / $15.14 / $29.84
| Professional | | $11.63 | $15.14 | $29.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.15 / $4.34 / $11.17
| Professional | 26 | $3.15 | $4.34 | $11.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.19 / $11.29 / $25.14
| Professional | TC | $8.19 | $11.29 | $25.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.28 / $32.28 / $32.28
| Facility | | $32.28 | $32.28 | $32.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $19.52 / $34.96
| Professional | | $11.75 | $19.52 | $34.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.15 / $6.08 / $9.74
| Professional | 26 | $4.15 | $6.08 | $9.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.52 / $14.12 / $25.10
| Professional | TC | $9.52 | $14.12 | $25.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.46 / $24.98 / $31.50
| Facility | | $23.46 | $24.98 | $31.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.02 / $6.02 / $6.02
| Facility | 26 | $6.02 | $6.02 | $6.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $15.67 / $34.35
| Professional | | $7.85 | $15.67 | $34.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.12 / $4.42 / $9.02
| Professional | 26 | $2.12 | $4.42 | $9.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.63 / $10.94 / $24.47
| Professional | TC | $5.63 | $10.94 | $24.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.96 / $32.96 / $34.61
| Facility | | $32.96 | $32.96 | $34.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.52 / $15.68 / $33.52
| Professional | | $9.52 | $15.68 | $33.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.69 / $4.46 / $8.55
| Professional | 26 | $2.69 | $4.46 | $8.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.71 / $11.19 / $24.62
| Professional | TC | $6.71 | $11.19 | $24.62 |