- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.67 / $41.46 / $44.41
| Professional | | $35.67 | $41.46 | $44.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.60 / $12.35 / $12.68
| Professional | 26 | $10.60 | $12.35 | $12.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.05 / $28.78 / $32.29
| Professional | TC | $25.05 | $28.78 | $32.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.19 / $73.19 / $73.19
| Facility | 26 | $73.19 | $73.19 | $73.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.06 / $60.19 / $184.61
| Professional | | $51.06 | $60.19 | $184.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.97 / $15.97 / $49.50
| Professional | 26 | $15.97 | $15.97 | $49.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.34 / $33.34 / $39.79
| Professional | TC | $33.34 | $33.34 | $39.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.84 / $63.83 / $184.61
| Professional | | $51.84 | $63.83 | $184.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.10 / $17.52 / $49.50
| Professional | 26 | $16.10 | $17.52 | $49.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.32 / $39.42 / $66.95
| Professional | TC | $34.32 | $39.42 | $66.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.35 / $59.24 / $184.61
| Professional | | $50.35 | $59.24 | $184.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.61 / $17.52 / $49.50
| Professional | 26 | $16.61 | $17.52 | $49.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.75 / $35.72 / $66.95
| Professional | TC | $33.75 | $35.72 | $66.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.79 / $57.76 / $160.91
| Professional | | $40.79 | $57.76 | $160.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.63 / $18.02 / $48.26
| Professional | 26 | $12.63 | $18.02 | $48.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.67 / $38.72 / $143.72
| Professional | TC | $25.67 | $38.72 | $143.72 |