- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.41 / $31.83 / $33.65
| Professional | | $27.41 | $31.83 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $9.40 / $9.48
| Professional | 26 | $7.95 | $9.40 | $9.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.46 / $22.35 / $24.25
| Professional | TC | $19.46 | $22.35 | $24.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.88 / $50.88 / $50.88
| Facility | 26 | $50.88 | $50.88 | $50.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.75 / $44.50 / $100.26
| Professional | | $37.75 | $44.50 | $100.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.21 / $11.21 / $36.59
| Professional | 26 | $11.21 | $11.21 | $36.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.33 / $25.33 / $29.86
| Professional | TC | $25.33 | $25.33 | $29.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.88 / $41.72 / $100.26
| Professional | | $34.88 | $41.72 | $100.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.97 / $12.57 / $36.59
| Professional | 26 | $10.97 | $12.57 | $36.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.31 / $29.39 / $47.26
| Professional | TC | $22.31 | $29.39 | $47.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.88 / $41.72 / $100.26
| Professional | | $34.88 | $41.72 | $100.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.31 / $12.57 / $36.59
| Professional | 26 | $11.31 | $12.57 | $36.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.31 / $28.41 / $41.82
| Professional | TC | $22.31 | $28.41 | $41.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.41 / $39.22 / $105.08
| Professional | | $27.41 | $39.22 | $105.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $12.97 / $38.93
| Professional | 26 | $8.91 | $12.97 | $38.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.80 / $26.26 / $67.72
| Professional | TC | $18.80 | $26.26 | $67.72 |