- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $72.44 / $194.98
| Professional | | $44.67 | $72.44 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $23.44 / $51.29
| Professional | 26 | $12.02 | $23.44 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.11 / $69.18 / $147.91
| Professional | TC | $33.11 | $69.18 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | 26 | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $229.09
| Professional | | $67.61 | $67.61 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $19.95 / $54.95
| Professional | 26 | $19.95 | $19.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.98 / $48.98 / $57.54
| Professional | TC | $48.98 | $48.98 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $77.62 / $165.96
| Professional | | $61.66 | $77.62 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $21.88 / $47.86
| Professional | 26 | $18.62 | $21.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.74 / $53.70 / $120.23
| Professional | TC | $40.74 | $53.70 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $229.09
| Professional | | $48.98 | $48.98 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $16.22 / $54.95
| Professional | 26 | $16.22 | $16.22 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Professional | TC | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $72.44 / $186.21
| Professional | | $51.29 | $72.44 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $19.50 / $43.65
| Professional | 26 | $14.13 | $19.50 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.48 / $47.86 / $141.25
| Professional | TC | $35.48 | $47.86 | $141.25 |