- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.46 / $84.70 / $84.70
| Facility | | $33.46 | $84.70 | $84.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.66 / $7.66 / $7.66
| Facility | 26 | $7.66 | $7.66 | $7.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.76 / $33.46 / $47.20
| Professional | | $23.76 | $33.46 | $47.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.08 / $6.50 / $7.66
| Professional | 26 | $5.08 | $6.50 | $7.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.68 / $25.80 / $41.79
| Professional | TC | $18.68 | $25.80 | $41.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.23 / $14.23 / $14.23
| Professional | | $14.23 | $14.23 | $14.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.04 / $7.33 / $8.06
| Professional | 26 | $3.04 | $7.33 | $8.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.91 / $57.68 / $68.06
| Professional | | $51.91 | $57.68 | $68.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.19 / $13.54 / $15.98
| Professional | 26 | $12.19 | $13.54 | $15.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.94 / $44.14 / $52.09
| Professional | TC | $38.94 | $44.14 | $52.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.42 / $18.18 / $62.00
| Professional | | $14.42 | $18.18 | $62.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.05 / $3.53 / $21.01
| Professional | 26 | $3.05 | $3.53 | $21.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.04 / $12.69 / $46.23
| Professional | TC | $11.04 | $12.69 | $46.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $28.67 / $45.49
| Professional | | $16.98 | $28.67 | $45.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.12 / $5.11 / $7.22
| Professional | 26 | $4.12 | $5.11 | $7.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.86 / $21.43 / $36.27
| Professional | TC | $12.86 | $21.43 | $36.27 |