- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.42 / $36.46 / $39.65
| Professional | | $31.42 | $36.46 | $39.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.22 / $9.60 / $11.08
| Professional | 26 | $8.22 | $9.60 | $11.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.19 / $26.64 / $28.90
| Professional | TC | $23.19 | $26.64 | $28.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.24 / $56.24 / $56.24
| Facility | 26 | $56.24 | $56.24 | $56.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.23 / $56.86 / $167.44
| Professional | | $48.23 | $56.86 | $167.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.51 / $13.51 / $45.18
| Professional | 26 | $13.51 | $13.51 | $45.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.34 / $34.34 / $40.47
| Professional | TC | $34.34 | $34.34 | $40.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.96 / $57.45 / $167.44
| Professional | | $44.96 | $57.45 | $167.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.75 / $15.27 / $45.18
| Professional | 26 | $12.75 | $15.27 | $45.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.85 / $36.59 / $59.66
| Professional | TC | $31.85 | $36.59 | $59.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.60 / $51.80 / $167.44
| Professional | | $44.60 | $51.80 | $167.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.75 / $15.22 / $45.18
| Professional | 26 | $12.75 | $15.22 | $45.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.85 / $34.38 / $59.66
| Professional | TC | $31.85 | $34.38 | $59.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $51.16 / $178.11
| Professional | | $36.69 | $51.16 | $178.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.32 / $15.16 / $48.06
| Professional | 26 | $11.32 | $15.16 | $48.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.37 / $36.61 / $130.05
| Professional | TC | $25.37 | $36.61 | $130.05 |