- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $45.71 / $169.82
| Professional | | $32.36 | $45.71 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $14.13 / $53.70
| Professional | 26 | $8.71 | $14.13 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $32.36 / $77.62
| Professional | TC | $23.44 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $61.66 / $61.66
| Professional | | $16.98 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $16.98 / $20.89
| Facility | 26 | $16.98 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $48.98 / $93.33
| Professional | | $29.51 | $48.98 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $14.13 / $26.92
| Professional | 26 | $7.76 | $14.13 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $34.67 / $67.61
| Professional | TC | $22.39 | $34.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $67.61 / $102.33
| Professional | | $54.95 | $67.61 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $16.98 / $20.89
| Facility | 26 | $16.98 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $87.10 / $104.71
| Professional | | $46.77 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $15.85 / $24.55
| Professional | 26 | $9.12 | $15.85 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $41.69 / $66.07
| Professional | TC | $23.99 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $38.90 / $64.57
| Professional | | $33.88 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $12.02 / $19.95
| Professional | 26 | $9.55 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $26.92 / $44.67
| Professional | TC | $23.44 | $26.92 | $44.67 |