- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.80 / $31.82 / $33.47
| Professional | | $30.80 | $31.82 | $33.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.68 / $10.01 / $10.18
| Professional | 26 | $9.68 | $10.01 | $10.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.12 / $21.63 / $23.48
| Professional | TC | $21.12 | $21.63 | $23.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.11 / $54.11 / $54.11
| Facility | 26 | $54.11 | $54.11 | $54.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $137.40
| Professional | | $40.65 | $40.65 | $137.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.66 / $12.66 / $40.86
| Professional | 26 | $12.66 | $12.66 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.19 / $28.19 / $28.19
| Professional | TC | $28.19 | $28.19 | $28.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.17 / $46.65 / $137.40
| Professional | | $40.17 | $46.65 | $137.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.00 / $14.26 / $40.86
| Professional | 26 | $12.00 | $14.26 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.94 / $29.78 / $47.58
| Professional | TC | $25.94 | $29.78 | $47.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.94 / $44.43 / $137.40
| Professional | | $37.94 | $44.43 | $137.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.28 / $14.26 / $40.86
| Professional | 26 | $12.28 | $14.26 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.67 / $27.94 / $47.50
| Professional | TC | $25.67 | $27.94 | $47.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $44.31 / $146.16
| Professional | | $30.17 | $44.31 | $146.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $13.31 / $38.78
| Professional | 26 | $9.94 | $13.31 | $38.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.22 / $30.92 / $102.69
| Professional | TC | $20.22 | $30.92 | $102.69 |