- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.92 / $27.06 / $99.09
| Facility | | $20.92 | $27.06 | $99.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.32 / $16.32 / $29.88
| Facility | 26 | $16.32 | $16.32 | $29.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $10.74 / $10.74 / $19.67
| Facility | TC | $10.74 | $10.74 | $19.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.48 / $16.02 / $16.02
| Professional | | $14.48 | $16.02 | $16.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.09 / $9.47 / $43.86
| Professional | 26 | $9.09 | $9.47 | $43.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.39 / $6.56 / $6.56
| Professional | TC | $5.39 | $6.56 | $6.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.27 / $20.27 / $34.67
| Professional | | $20.27 | $20.27 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.35 / $11.93 / $16.97
| Professional | 26 | $8.35 | $11.93 | $16.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.84 / $7.09 / $8.34
| Professional | TC | $5.84 | $7.09 | $8.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.25 / $16.25 / $16.25
| Facility | | $16.25 | $16.25 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.93 / $25.93 / $36.25
| Professional | | $10.93 | $25.93 | $36.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.40 / $16.94 / $21.41
| Professional | 26 | $6.40 | $16.94 | $21.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.51 / $9.35 / $14.95
| Professional | TC | $4.51 | $9.35 | $14.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $22.83 / $34.81
| Professional | | $8.51 | $22.83 | $34.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.12 / $15.04 / $20.30
| Professional | 26 | $6.12 | $15.04 | $20.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.61 / $9.44 / $14.50
| Professional | TC | $2.61 | $9.44 | $14.50 |