- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.91 / $33.60 / $35.35
| Professional | | $28.91 | $33.60 | $35.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $9.93 / $10.18
| Professional | 26 | $8.51 | $9.93 | $10.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.39 / $23.42 / $25.42
| Professional | TC | $20.39 | $23.42 | $25.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.37 / $58.37 / $58.37
| Facility | 26 | $58.37 | $58.37 | $58.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.40 / $49.98 / $143.16
| Professional | | $42.40 | $49.98 | $143.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.15 / $13.15 / $39.47
| Professional | 26 | $13.15 | $13.15 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.38 / $30.38 / $35.81
| Professional | TC | $30.38 | $30.38 | $35.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.68 / $48.62 / $143.16
| Professional | | $40.68 | $48.62 | $143.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.83 / $14.01 / $39.47
| Professional | 26 | $12.83 | $14.01 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.93 / $32.61 / $52.12
| Professional | TC | $26.93 | $32.61 | $52.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.52 / $48.41 / $143.16
| Professional | | $40.52 | $48.41 | $143.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.24 / $14.01 / $39.47
| Professional | 26 | $13.24 | $14.01 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.44 / $30.19 / $50.74
| Professional | TC | $26.44 | $30.19 | $50.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.76 / $47.90 / $152.28
| Professional | | $31.76 | $47.90 | $152.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.07 / $14.48 / $41.99
| Professional | 26 | $10.07 | $14.48 | $41.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.69 / $32.97 / $110.29
| Professional | TC | $21.69 | $32.97 | $110.29 |