- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.89 / $34.68 / $38.56
| Professional | | $29.89 | $34.68 | $38.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.55 / $8.75
| Professional | 26 | $7.33 | $8.55 | $8.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.57 / $25.92 / $29.93
| Professional | TC | $22.57 | $25.92 | $29.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.85 / $49.85 / $49.85
| Facility | 26 | $49.85 | $49.85 | $49.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.62 / $49.06 / $163.12
| Professional | | $41.62 | $49.06 | $163.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.31 / $11.31 / $35.15
| Professional | 26 | $11.31 | $11.31 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.65 / $30.65 / $36.86
| Professional | TC | $30.65 | $30.65 | $36.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.18 / $54.98 / $163.12
| Professional | | $43.18 | $54.98 | $163.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.97 / $12.08 / $35.15
| Professional | 26 | $10.97 | $12.08 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.20 / $35.35 / $62.09
| Professional | TC | $31.20 | $35.35 | $62.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.78 / $48.38 / $163.12
| Professional | | $40.78 | $48.38 | $163.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.31 / $12.08 / $35.15
| Professional | 26 | $11.31 | $12.08 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.47 / $33.34 / $62.09
| Professional | TC | $29.47 | $33.34 | $62.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.97 / $47.29 / $173.52
| Professional | | $34.97 | $47.29 | $173.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.60 / $12.45 / $37.40
| Professional | 26 | $8.60 | $12.45 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.40 / $35.85 / $136.12
| Professional | TC | $26.40 | $35.85 | $136.12 |