- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $28.84 / $40.74
| Professional | | $17.38 | $28.84 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $8.91 / $30.20
| Professional | 26 | $6.03 | $8.91 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $21.88 / $28.84
| Professional | TC | $15.14 | $21.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $125.89
| Professional | | $33.11 | $33.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $10.23 / $33.88
| Professional | 26 | $10.23 | $10.23 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $22.91 / $27.54
| Professional | TC | $22.91 | $22.91 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $43.65 / $89.13
| Professional | | $36.31 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $11.75 / $25.12
| Professional | 26 | $10.00 | $11.75 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $30.20 / $66.07
| Professional | TC | $25.12 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $27.54 / $125.89
| Professional | | $27.54 | $27.54 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $8.51 / $33.88
| Professional | 26 | $8.51 | $8.51 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $19.50 / $19.50
| Professional | TC | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $41.69 / $100.00
| Professional | | $29.51 | $41.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $12.02 / $27.54
| Professional | 26 | $8.51 | $12.02 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $27.54 / $74.13
| Professional | TC | $19.95 | $27.54 | $74.13 |