- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.71 / $55.42 / $58.43
| Professional | | $47.71 | $55.42 | $58.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.61 / $15.96 / $16.27
| Professional | 26 | $13.61 | $15.96 | $16.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.09 / $39.15 / $42.47
| Professional | TC | $34.09 | $39.15 | $42.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.17 / $91.17 / $91.17
| Facility | 26 | $91.17 | $91.17 | $91.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.84 / $78.81 / $227.51
| Professional | | $66.84 | $78.81 | $227.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.77 / $19.77 / $55.21
| Professional | 26 | $19.77 | $19.77 | $55.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.30 / $49.30 / $58.12
| Professional | TC | $49.30 | $49.30 | $58.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.99 / $79.03 / $227.51
| Professional | | $61.99 | $79.03 | $227.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.97 / $21.65 / $55.21
| Professional | 26 | $18.97 | $21.65 | $55.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.74 / $53.60 / $85.68
| Professional | TC | $40.74 | $53.60 | $85.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.52 / $78.30 / $227.51
| Professional | | $61.52 | $78.30 | $227.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.97 / $21.65 / $55.21
| Professional | 26 | $18.97 | $21.65 | $55.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.72 / $48.81 / $83.18
| Professional | TC | $39.72 | $48.81 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.63 / $72.69 / $242.01
| Professional | | $50.63 | $72.69 | $242.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.24 / $20.27 / $58.73
| Professional | 26 | $14.24 | $20.27 | $58.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.32 / $52.53 / $183.28
| Professional | TC | $35.32 | $52.53 | $183.28 |