- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $33.11 / $85.11
| Professional | | $21.88 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $7.94 / $26.92
| Professional | 26 | $6.03 | $7.94 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $25.12 / $37.15
| Professional | TC | $15.14 | $25.12 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | 26 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $141.25
| Professional | | $40.74 | $40.74 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $11.22 / $33.88
| Professional | 26 | $11.22 | $11.22 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $27.54 / $32.36
| Professional | TC | $27.54 | $27.54 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $43.65 / $102.33
| Professional | | $37.15 | $43.65 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $12.02 / $26.30
| Professional | 26 | $10.72 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $30.90 / $77.62
| Professional | TC | $25.70 | $30.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $141.25
| Professional | | $30.20 | $30.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $8.91 / $33.88
| Professional | 26 | $8.91 | $8.91 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | TC | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $41.69 / $114.82
| Professional | | $32.36 | $41.69 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $11.48 / $28.84
| Professional | 26 | $8.71 | $11.48 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $29.51 / $87.10
| Professional | TC | $22.39 | $29.51 | $87.10 |