- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.26 / $75.53 / $141.47
| Facility | | $41.26 | $75.53 | $141.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.22 / $9.22 / $16.87
| Facility | 26 | $9.22 | $9.22 | $16.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.45 / $25.45 / $42.10
| Professional | | $25.45 | $25.45 | $42.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.94 / $5.21 / $12.45
| Professional | 26 | $4.94 | $5.21 | $12.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.23 / $20.23 / $37.15
| Professional | TC | $20.23 | $20.23 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.43 / $33.43 / $52.97
| Professional | | $33.43 | $33.43 | $52.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.62 / $6.60 / $9.42
| Professional | 26 | $4.62 | $6.60 | $9.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.77 / $22.80 / $26.82
| Professional | TC | $18.77 | $22.80 | $26.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.23 / $41.23 / $41.23
| Facility | | $41.23 | $41.23 | $41.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.78 / $41.46 / $73.27
| Professional | | $16.78 | $41.46 | $73.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.55 / $9.40 / $12.00
| Professional | 26 | $3.55 | $9.40 | $12.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.23 / $31.82 / $64.26
| Professional | TC | $13.23 | $31.82 | $64.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.76 / $32.78 / $58.66
| Professional | | $16.76 | $32.78 | $58.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.01 / $7.43 / $11.50
| Professional | 26 | $3.01 | $7.43 | $11.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.53 / $32.77 / $51.97
| Professional | TC | $18.53 | $32.77 | $51.97 |