- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $44.67 / $109.65
| Professional | | $28.84 | $44.67 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $15.14 / $46.77
| Professional | 26 | $10.00 | $15.14 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $32.36 / $109.65
| Professional | TC | $18.20 | $32.36 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | 26 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $186.21
| Professional | | $54.95 | $54.95 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.78 / $17.78 / $57.54
| Professional | 26 | $17.78 | $17.78 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.02 / $38.02 / $44.67
| Professional | TC | $38.02 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $61.66 / $134.90
| Professional | | $51.29 | $61.66 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $20.42 / $41.69
| Professional | 26 | $16.98 | $20.42 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.11 / $39.81 / $93.33
| Professional | TC | $33.11 | $39.81 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $186.21
| Professional | | $41.69 | $41.69 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $13.80 / $57.54
| Professional | 26 | $13.80 | $13.80 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.18 / $28.18 / $28.18
| Professional | TC | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $58.88 / $151.36
| Professional | | $43.65 | $58.88 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $18.20 / $46.77
| Professional | 26 | $14.45 | $18.20 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $39.81 / $104.71
| Professional | TC | $26.92 | $39.81 | $104.71 |