- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $43.65 / $154.88
| Professional | | $30.20 | $43.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $16.98 / $38.90
| Professional | 26 | $10.00 | $16.98 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $30.90 / $102.33
| Professional | TC | $19.95 | $30.90 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $56.23 / $181.97
| Professional | | $47.86 | $56.23 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $15.85 / $52.48
| Professional | 26 | $15.85 | $15.85 | $52.48 |
- 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
- $50.12 / $61.66 / $131.83
| Professional | | $50.12 | $61.66 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.49 / $18.62 / $39.81
| Professional | 26 | $15.49 | $18.62 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.11 / $39.81 / $93.33
| Professional | TC | $33.11 | $39.81 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $181.97
| Professional | | $38.90 | $38.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $13.49 / $52.48
| Professional | 26 | $13.49 | $13.49 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $25.70 / $25.70
| Professional | TC | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $57.54 / $147.91
| Professional | | $42.66 | $57.54 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $19.05 / $42.66
| Professional | 26 | $13.49 | $19.05 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $37.15 / $104.71
| Professional | TC | $26.92 | $37.15 | $104.71 |