- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $54.95 / $190.55
| Professional | | $37.15 | $54.95 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $12.88 / $43.65
| Professional | 26 | $8.91 | $12.88 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $41.69 / $104.71
| Professional | TC | $26.92 | $41.69 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $223.87
| Professional | | $61.66 | $61.66 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.49 / $15.49 / $47.86
| Professional | 26 | $15.49 | $15.49 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.71 / $45.71 / $53.70
| Professional | TC | $45.71 | $45.71 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $70.79 / $162.18
| Professional | | $60.26 | $70.79 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $17.38 / $38.02
| Professional | 26 | $14.79 | $17.38 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.65 / $52.48 / $128.82
| Professional | TC | $43.65 | $52.48 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $223.87
| Professional | | $50.12 | $50.12 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $12.88 / $47.86
| Professional | 26 | $12.88 | $12.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | TC | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $64.57 / $181.97
| Professional | | $52.48 | $64.57 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $16.22 / $38.90
| Professional | 26 | $12.30 | $16.22 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.02 / $50.12 / $144.54
| Professional | TC | $38.02 | $50.12 | $144.54 |