- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $34.67 / $123.03
| Professional | | $21.88 | $34.67 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $11.48 / $34.67
| Professional | 26 | $7.59 | $11.48 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $25.12 / $87.10
| Professional | TC | $15.14 | $25.12 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | 26 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $50.12 / $144.54
| Professional | | $42.66 | $50.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $13.18 / $39.81
| Professional | 26 | $13.18 | $13.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $30.20 / $35.48
| Professional | TC | $30.20 | $30.20 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $47.86 / $102.33
| Professional | | $40.74 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $14.13 / $29.51
| Professional | 26 | $12.88 | $14.13 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $32.36 / $74.13
| Professional | TC | $26.92 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $144.54
| Professional | | $32.36 | $32.36 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $10.23 / $39.81
| Professional | 26 | $10.23 | $10.23 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $22.39 / $22.39
| Professional | TC | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $46.77 / $114.82
| Professional | | $33.11 | $46.77 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $13.49 / $32.36
| Professional | 26 | $10.00 | $13.49 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $31.62 / $83.18
| Professional | TC | $21.88 | $31.62 | $83.18 |