- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.73 / $137.08 / $274.16
| Facility | | $17.73 | $137.08 | $274.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.41 / $10.41 / $12.13
| Facility | 26 | $10.41 | $10.41 | $12.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $7.30 / $7.30 / $8.33
| Facility | TC | $7.30 | $7.30 | $8.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.97 / $16.00 / $17.73
| Professional | | $12.97 | $16.00 | $17.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.71 / $10.07 / $10.42
| Professional | 26 | $7.71 | $10.07 | $10.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.26 / $5.92 / $7.31
| Professional | TC | $5.26 | $5.92 | $7.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.86 / $13.98 / $45.01
| Professional | | $8.86 | $13.98 | $45.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.76 / $8.34 / $32.15
| Professional | 26 | $5.76 | $8.34 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.10 / $5.64 / $12.85
| Professional | TC | $3.10 | $5.64 | $12.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.91 / $17.91 / $17.91
| Professional | | $17.91 | $17.91 | $17.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.17 / $10.37 / $10.57
| Professional | 26 | $10.17 | $10.37 | $10.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.21 / $20.77 / $49.17
| Professional | | $12.21 | $20.77 | $49.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.77 / $12.48 / $28.91
| Professional | 26 | $7.77 | $12.48 | $28.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.65 / $7.22 / $20.26
| Professional | TC | $4.65 | $7.22 | $20.26 |