- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $45.71 / $93.33
| Professional | | $30.20 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.02 / $29.51
| Professional | 26 | $7.94 | $12.02 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $34.67 / $83.18
| Professional | TC | $21.88 | $34.67 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | 26 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $190.55
| Professional | | $57.54 | $57.54 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $15.14 / $48.98
| Professional | 26 | $15.14 | $15.14 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.66 / $42.66 / $50.12
| Professional | TC | $42.66 | $42.66 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $64.57 / $144.54
| Professional | | $53.70 | $64.57 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $16.98 / $34.67
| Professional | 26 | $14.13 | $16.98 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.90 / $47.86 / $109.65
| Professional | TC | $38.90 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $45.71 / $190.55
| Professional | | $45.71 | $45.71 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $10.96 / $48.98
| Professional | 26 | $10.96 | $10.96 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Professional | TC | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $61.66 / $154.88
| Professional | | $43.65 | $61.66 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $15.14 / $39.81
| Professional | 26 | $12.02 | $15.14 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $43.65 / $114.82
| Professional | TC | $30.90 | $43.65 | $114.82 |