- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $48.98 / $67.61
| Professional | | $33.11 | $48.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $14.13 / $47.86
| Professional | 26 | $10.00 | $14.13 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $34.67 / $64.57
| Professional | TC | $21.88 | $34.67 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | 26 | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $204.17
| Professional | | $61.66 | $61.66 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.78 / $17.78 / $56.23
| Professional | 26 | $17.78 | $17.78 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.65 / $43.65 / $51.29
| Professional | TC | $43.65 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $66.07 / $147.91
| Professional | | $56.23 | $66.07 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $19.50 / $42.66
| Professional | 26 | $17.38 | $19.50 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.02 / $43.65 / $107.15
| Professional | TC | $38.02 | $43.65 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $204.17
| Professional | | $44.67 | $44.67 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $56.23
| Professional | 26 | $14.13 | $14.13 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | TC | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $63.10 / $165.96
| Professional | | $46.77 | $63.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $18.62 / $45.71
| Professional | 26 | $14.13 | $18.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $42.66 / $120.23
| Professional | TC | $30.90 | $42.66 | $120.23 |