- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $85.11 / $85.11
| Facility | | $33.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $7.59 / $7.59
| Facility | 26 | $7.59 | $7.59 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $29.51 / $77.62
| Professional | | $19.05 | $29.51 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.98 / $11.75 / $41.69
| Professional | 26 | $3.98 | $11.75 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $21.88 / $40.74
| Professional | TC | $15.14 | $21.88 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $14.45 / $14.45
| Professional | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $8.71 / $8.71
| Professional | 26 | $8.71 | $8.71 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $57.54 / $67.61
| Professional | | $52.48 | $57.54 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $13.49 / $15.85
| Professional | 26 | $12.30 | $13.49 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.90 / $43.65 / $52.48
| Professional | TC | $38.90 | $43.65 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $18.20 / $77.62
| Professional | | $14.45 | $18.20 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $3.55 / $20.89
| Professional | 26 | $3.02 | $3.55 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.96 / $12.59 / $66.07
| Professional | TC | $10.96 | $12.59 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $30.90 / $46.77
| Professional | | $16.98 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.07 / $5.75 / $7.24
| Professional | 26 | $4.07 | $5.75 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $23.99 / $36.31
| Professional | TC | $12.88 | $23.99 | $36.31 |