- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $38.90 / $154.88
| Professional | | $23.99 | $38.90 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.02 / $26.30
| Professional | 26 | $7.94 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.85 / $28.18 / $57.54
| Professional | TC | $15.85 | $28.18 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.13 / $45.71
| Professional | | $14.13 | $14.13 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $17.38
| Facility | 26 | $14.13 | $14.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $45.71 / $85.11
| Professional | | $32.36 | $45.71 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $14.13 / $25.12
| Professional | 26 | $9.33 | $14.13 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $31.62 / $60.26
| Professional | TC | $22.91 | $31.62 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $51.29 / $93.33
| Professional | | $50.12 | $51.29 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $17.38
| Facility | 26 | $14.13 | $14.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $64.57 / $85.11
| Professional | | $41.69 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $14.45 / $21.38
| Professional | 26 | $9.55 | $14.45 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $32.36 / $47.86
| Professional | TC | $20.42 | $32.36 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $36.31 / $57.54
| Professional | | $31.62 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $10.72 / $17.38
| Professional | 26 | $9.77 | $10.72 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $25.12 / $40.74
| Professional | TC | $21.88 | $25.12 | $40.74 |