- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $25.03 / $26.33
| Professional | | $21.53 | $25.03 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.74 / $7.89 / $8.03
| Professional | 26 | $6.74 | $7.89 | $8.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.78 / $16.98 / $18.44
| Professional | TC | $14.78 | $16.98 | $18.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.61 / $45.61 / $45.61
| Facility | 26 | $45.61 | $45.61 | $45.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.56 / $32.50 / $104.53
| Professional | | $27.56 | $32.50 | $104.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.41 / $9.41 / $32.28
| Professional | 26 | $9.41 | $9.41 | $32.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.51 / $18.51 / $21.83
| Professional | TC | $18.51 | $18.51 | $21.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $35.36 / $104.53
| Professional | | $30.23 | $35.36 | $104.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.02 / $11.09 / $32.28
| Professional | 26 | $10.02 | $11.09 | $32.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.54 / $23.54 / $37.60
| Professional | TC | $19.54 | $23.54 | $37.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.19 / $35.36 / $104.53
| Professional | | $30.19 | $35.36 | $104.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.34 / $11.09 / $32.28
| Professional | 26 | $10.34 | $11.09 | $32.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.54 / $21.14 / $36.15
| Professional | TC | $19.54 | $21.14 | $36.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.31 / $34.77 / $111.20
| Professional | | $23.31 | $34.77 | $111.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.89 / $11.44 / $30.64
| Professional | 26 | $7.89 | $11.44 | $30.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.42 / $22.69 / $76.86
| Professional | TC | $15.42 | $22.69 | $76.86 |