- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.58 / $34.40 / $344.50
| Facility | | $30.58 | $34.40 | $344.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.95 / $6.95 / $8.52
| Facility | 26 | $6.95 | $6.95 | $8.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.60 / $36.97 / $99.19
| Professional | | $19.60 | $36.97 | $99.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.40 / $7.67 / $13.92
| Professional | 26 | $5.40 | $7.67 | $13.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.45 / $27.81 / $50.16
| Professional | TC | $15.45 | $27.81 | $50.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.06 / $29.06 / $49.48
| Professional | | $29.06 | $29.06 | $49.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.23 / $6.23 / $11.00
| Professional | 26 | $6.23 | $6.23 | $11.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.83 / $22.83 / $22.83
| Professional | TC | $22.83 | $22.83 | $22.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.63 / $39.44 / $68.54
| Professional | | $32.63 | $39.44 | $68.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.36 / $8.23 / $12.59
| Professional | 26 | $7.36 | $8.23 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.38 / $31.21 / $55.37
| Professional | TC | $19.38 | $31.21 | $55.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.57 / $28.92 / $28.92
| Facility | | $27.57 | $28.92 | $28.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.09 / $6.09 / $6.09
| Professional | 26 | $6.09 | $6.09 | $6.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.53 / $25.58 / $62.10
| Professional | | $14.53 | $25.58 | $62.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.12 / $4.69 / $13.59
| Professional | 26 | $3.12 | $4.69 | $13.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.40 / $20.89 / $51.74
| Professional | TC | $11.40 | $20.89 | $51.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $32.75 / $76.52
| Professional | | $17.98 | $32.75 | $76.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.33 / $7.62 / $13.57
| Professional | 26 | $4.33 | $7.62 | $13.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.51 / $26.60 / $72.15
| Professional | TC | $14.51 | $26.60 | $72.15 |