- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.50 / $49.50 / $58.85
| Facility | | $49.50 | $49.50 | $58.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.74 / $33.74 / $33.74
| Facility | 26 | $33.74 | $33.74 | $33.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.84 / $45.81 / $58.85
| Professional | | $34.84 | $45.81 | $58.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.75 / $27.41 / $33.74
| Professional | 26 | $22.75 | $27.41 | $33.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.88 / $18.39 / $25.10
| Professional | TC | $9.88 | $18.39 | $25.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.79 / $32.79 / $32.79
| Professional | 26 | $32.79 | $32.79 | $32.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.00 / $65.00 / $76.70
| Professional | | $65.00 | $65.00 | $76.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.90 / $57.00 / $67.26
| Professional | 26 | $54.90 | $57.00 | $67.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.00 / $8.00 / $9.44
| Professional | TC | $8.00 | $8.00 | $9.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.22 / $26.10 / $65.00
| Professional | | $21.22 | $26.10 | $65.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.92 / $15.71 / $59.00
| Professional | 26 | $13.92 | $15.71 | $59.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.97 / $10.39 / $22.67
| Professional | TC | $5.97 | $10.39 | $22.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.98 / $33.35 / $55.58
| Professional | | $30.98 | $33.35 | $55.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.70 / $23.54 / $32.47
| Professional | 26 | $18.70 | $23.54 | $32.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.40 / $12.71 / $23.10
| Professional | TC | $7.40 | $12.71 | $23.10 |