- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $39.81 / $95.50
| Professional | | $25.12 | $39.81 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.46 / $10.96 / $28.84
| Professional | 26 | $6.46 | $10.96 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $30.90 / $77.62
| Professional | TC | $19.05 | $30.90 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | 26 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $48.98 / $162.18
| Professional | | $41.69 | $48.98 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $11.22 / $35.48
| Professional | 26 | $11.22 | $11.22 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $30.90 / $37.15
| Professional | TC | $30.90 | $30.90 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $47.86 / $114.82
| Professional | | $40.74 | $47.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $12.02 / $26.30
| Professional | 26 | $10.72 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $37.15 / $91.20
| Professional | TC | $29.51 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $162.18
| Professional | | $34.67 | $34.67 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $8.91 / $35.48
| Professional | 26 | $8.91 | $8.91 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $25.70 / $25.70
| Professional | TC | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $45.71 / $128.82
| Professional | | $37.15 | $45.71 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $11.48 / $27.54
| Professional | 26 | $8.51 | $11.48 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $33.88 / $102.33
| Professional | TC | $26.30 | $33.88 | $102.33 |