- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.92 / $38.26 / $40.34
| Professional | | $32.92 | $38.26 | $40.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.02 / $11.82 / $11.98
| Professional | 26 | $10.02 | $11.82 | $11.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.87 / $26.28 / $28.52
| Professional | TC | $22.87 | $26.28 | $28.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.76 / $65.76 / $65.76
| Facility | 26 | $65.76 | $65.76 | $65.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.94 / $55.33 / $147.43
| Professional | | $46.94 | $55.33 | $147.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.05 / $14.05 / $42.30
| Professional | 26 | $14.05 | $14.05 | $42.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.79 / $31.79 / $37.47
| Professional | TC | $31.79 | $31.79 | $37.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.72 / $50.58 / $147.43
| Professional | | $43.72 | $50.58 | $147.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.23 / $15.44 / $42.30
| Professional | 26 | $14.23 | $15.44 | $42.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.49 / $35.45 / $56.65
| Professional | TC | $29.49 | $35.45 | $56.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.99 / $50.58 / $147.43
| Professional | | $41.99 | $50.58 | $147.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.54 / $15.44 / $42.30
| Professional | 26 | $14.54 | $15.44 | $42.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.93 / $32.20 / $52.36
| Professional | TC | $26.93 | $32.20 | $52.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.29 / $51.73 / $156.83
| Professional | | $34.29 | $51.73 | $156.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.19 / $16.84 / $41.48
| Professional | 26 | $11.19 | $16.84 | $41.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.13 / $34.89 / $111.83
| Professional | TC | $23.13 | $34.89 | $111.83 |