- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $38.02 / $141.25
| Professional | | $25.70 | $38.02 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $11.48 / $38.90
| Professional | 26 | $8.71 | $11.48 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $25.70 / $91.20
| Professional | TC | $16.98 | $25.70 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Facility | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $54.95 / $147.91
| Professional | | $46.77 | $54.95 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $42.66
| Professional | 26 | $14.13 | $14.13 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $31.62 / $37.15
| Professional | TC | $31.62 | $31.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $50.12 / $117.49
| Professional | | $43.65 | $50.12 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $15.49 / $34.67
| Professional | 26 | $13.18 | $15.49 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $35.48 / $79.43
| Professional | TC | $29.51 | $35.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $147.91
| Professional | | $37.15 | $37.15 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $11.75 / $42.66
| Professional | 26 | $11.75 | $11.75 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $25.12 / $25.12
| Professional | TC | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $48.98 / $120.23
| Professional | | $34.67 | $48.98 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $14.45 / $34.67
| Professional | 26 | $11.22 | $14.45 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $33.11 / $85.11
| Professional | TC | $22.91 | $33.11 | $85.11 |