- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.97 / $46.47 / $48.84
| Professional | | $39.97 | $46.47 | $48.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.10 / $13.86 / $14.47
| Professional | 26 | $12.10 | $13.86 | $14.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.87 / $32.00 / $34.72
| Professional | TC | $27.87 | $32.00 | $34.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.65 / $81.65 / $81.65
| Facility | 26 | $81.65 | $81.65 | $81.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.18 / $72.13 / $204.62
| Professional | | $61.18 | $72.13 | $204.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.87 / $21.08 / $56.64
| Professional | 26 | $17.87 | $21.08 | $56.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.23 / $43.23 / $50.96
| Professional | TC | $43.23 | $43.23 | $50.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.74 / $69.72 / $204.62
| Professional | | $57.74 | $69.72 | $204.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.97 / $19.53 / $56.64
| Professional | 26 | $17.97 | $19.53 | $56.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.26 / $43.96 / $73.45
| Professional | TC | $38.26 | $43.96 | $73.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.74 / $66.06 / $204.62
| Professional | | $57.74 | $66.06 | $204.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.53 / $19.53 / $56.64
| Professional | 26 | $18.53 | $19.53 | $56.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.79 / $41.28 / $73.45
| Professional | TC | $37.79 | $41.28 | $73.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.92 / $64.61 / $177.26
| Professional | | $44.92 | $64.61 | $177.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.10 / $20.05 / $60.26
| Professional | 26 | $14.10 | $20.05 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.20 / $44.04 / $157.41
| Professional | TC | $31.20 | $44.04 | $157.41 |