- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $44.67 / $151.36
| Professional | | $32.36 | $44.67 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $14.79 / $41.69
| Professional | 26 | $10.00 | $14.79 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $31.62 / $69.18
| Professional | TC | $22.91 | $31.62 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $58.88
| Professional | | $16.22 | $16.22 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $16.22 / $19.95
| Facility | 26 | $16.22 | $16.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $50.12 / $91.20
| Professional | | $33.88 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $16.22 / $29.51
| Professional | 26 | $10.00 | $16.22 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $36.31 / $64.57
| Professional | TC | $22.91 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $64.57 / $97.72
| Professional | | $61.66 | $64.57 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $16.22 / $19.95
| Facility | 26 | $16.22 | $16.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $83.18 / $102.33
| Professional | | $51.29 | $83.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.98 / $24.55
| Professional | 26 | $10.96 | $16.98 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $40.74 / $63.10
| Professional | TC | $26.30 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $38.02 / $63.10
| Professional | | $37.15 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $12.59 / $20.42
| Professional | 26 | $11.48 | $12.59 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $25.70 / $44.67
| Professional | TC | $24.55 | $25.70 | $44.67 |