- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $34.67 / $102.33
| Professional | | $19.50 | $34.67 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.88 / $34.67
| Professional | 26 | $7.94 | $12.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.85 / $25.12 / $58.88
| Professional | TC | $15.85 | $25.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $141.25
| Professional | | $36.31 | $36.31 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $11.48 / $38.02
| Professional | 26 | $11.48 | $11.48 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $24.55 / $28.84
| Professional | TC | $24.55 | $24.55 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $46.77 / $100.00
| Professional | | $38.02 | $46.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $13.18 / $28.18
| Professional | 26 | $11.22 | $13.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $31.62 / $74.13
| Professional | TC | $25.70 | $31.62 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $29.51 / $141.25
| Professional | | $29.51 | $29.51 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $9.55 / $38.02
| Professional | 26 | $9.55 | $9.55 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $19.95 / $19.95
| Professional | TC | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $43.65 / $114.82
| Professional | | $32.36 | $43.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $13.49 / $30.90
| Professional | 26 | $9.77 | $13.49 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $28.84 / $83.18
| Professional | TC | $21.38 | $28.84 | $83.18 |