- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.78 / $31.10 / $33.15
| Professional | | $26.78 | $31.10 | $33.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.55 / $8.75
| Professional | 26 | $7.33 | $8.55 | $8.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.46 / $22.35 / $24.87
| Professional | TC | $19.46 | $22.35 | $24.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.85 / $49.85 / $49.85
| Facility | 26 | $49.85 | $49.85 | $49.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.61 / $47.88 / $140.28
| Professional | | $40.61 | $47.88 | $140.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.31 / $13.33 / $33.72
| Professional | 26 | $11.31 | $13.33 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.58 / $27.58 / $32.52
| Professional | TC | $27.58 | $27.58 | $32.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $49.10 / $140.28
| Professional | | $38.76 | $49.10 | $140.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.97 / $12.08 / $33.72
| Professional | 26 | $10.97 | $12.08 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.93 / $30.41 / $52.36
| Professional | TC | $26.93 | $30.41 | $52.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.36 / $43.84 / $140.28
| Professional | | $38.36 | $43.84 | $140.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.31 / $12.08 / $33.72
| Professional | 26 | $11.31 | $12.08 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.67 / $27.61 / $52.36
| Professional | TC | $25.67 | $27.61 | $52.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.86 / $44.64 / $149.22
| Professional | | $30.86 | $44.64 | $149.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.61 / $12.99 / $35.86
| Professional | 26 | $8.61 | $12.99 | $35.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.29 / $30.23 / $113.35
| Professional | TC | $22.29 | $30.23 | $113.35 |