- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.92 / $43.98 / $46.60
| Professional | | $37.92 | $43.98 | $46.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.75 / $11.49 / $12.46
| Professional | 26 | $9.75 | $11.49 | $12.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.17 / $32.36 / $35.11
| Professional | TC | $28.17 | $32.36 | $35.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.62 / $63.62 / $63.62
| Facility | 26 | $63.62 | $63.62 | $63.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.01 / $51.01 / $180.34
| Professional | | $51.01 | $51.01 | $180.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.10 / $15.10 / $50.89
| Professional | 26 | $15.10 | $15.10 | $50.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.93 / $35.93 / $42.35
| Professional | TC | $35.93 | $35.93 | $42.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.01 / $61.38 / $180.34
| Professional | | $52.01 | $61.38 | $180.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.20 / $17.50 / $50.89
| Professional | 26 | $14.20 | $17.50 | $50.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.27 / $42.83 / $68.45
| Professional | TC | $37.27 | $42.83 | $68.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.32 / $60.05 / $180.34
| Professional | | $50.32 | $60.05 | $180.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.20 / $17.22 / $50.89
| Professional | 26 | $14.20 | $17.22 | $50.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.13 / $38.24 / $62.91
| Professional | TC | $36.13 | $38.24 | $62.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.91 / $57.73 / $191.84
| Professional | | $41.91 | $57.73 | $191.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.34 / $16.55 / $54.14
| Professional | 26 | $12.34 | $16.55 | $54.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.48 / $40.33 / $137.69
| Professional | TC | $27.48 | $40.33 | $137.69 |