- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.76 / $63.76 / $116.71
| Facility | | $63.76 | $63.76 | $116.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.86 / $39.86 / $72.97
| Facility | 26 | $39.86 | $39.86 | $72.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.22 / $34.54 / $34.54
| Professional | | $31.22 | $34.54 | $34.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.33 / $23.61 / $56.00
| Professional | 26 | $22.33 | $23.61 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.89 / $10.92 / $10.92
| Professional | TC | $8.89 | $10.92 | $10.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.52 / $54.73 / $73.64
| Professional | | $46.52 | $54.73 | $73.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.71 / $29.58 / $41.53
| Professional | 26 | $20.71 | $29.58 | $41.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.60 / $21.37 / $25.14
| Professional | TC | $17.60 | $21.37 | $25.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.22 / $36.22 / $36.22
| Facility | | $36.22 | $36.22 | $36.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.66 / $56.67 / $96.62
| Professional | | $25.66 | $56.67 | $96.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.67 / $42.40 / $52.59
| Professional | 26 | $15.67 | $42.40 | $52.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.68 / $15.92 / $45.15
| Professional | TC | $7.68 | $15.92 | $45.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.89 / $57.73 / $82.54
| Professional | | $18.89 | $57.73 | $82.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.04 / $37.01 / $50.09
| Professional | 26 | $15.04 | $37.01 | $50.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.85 / $24.21 / $33.33
| Professional | TC | $3.85 | $24.21 | $33.33 |