- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.92 / $36.67 / $146.43
| Professional | | $32.92 | $36.67 | $146.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.58 / $10.75 / $25.37
| Professional | 26 | $9.58 | $10.75 | $25.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.87 / $25.92 / $42.63
| Professional | TC | $22.87 | $25.92 | $42.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.77 / $54.68
| Professional | | $15.77 | $15.77 | $54.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.77 / $15.77 / $19.50
| Facility | 26 | $15.77 | $15.77 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.53 / $46.50 / $78.36
| Professional | | $31.53 | $46.50 | $78.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.70 / $15.77 / $25.45
| Professional | 26 | $10.70 | $15.77 | $25.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.85 / $34.92 / $50.79
| Professional | TC | $24.85 | $34.92 | $50.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.77 / $15.77 / $19.50
| Facility | 26 | $15.77 | $15.77 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.64 / $54.71 / $87.15
| Professional | | $33.64 | $54.71 | $87.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $16.82 / $23.51
| Professional | 26 | $10.36 | $16.82 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.18 / $36.93 / $52.83
| Professional | TC | $24.18 | $36.93 | $52.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.79 / $35.03 / $60.85
| Professional | | $30.79 | $35.03 | $60.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.10 / $11.80 / $19.64
| Professional | 26 | $11.10 | $11.80 | $19.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.23 / $23.46 / $41.20
| Professional | TC | $23.23 | $23.46 | $41.20 |