- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.51 / $35.40 / $37.53
| Professional | | $30.51 | $35.40 | $37.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.25 / $9.44 / $9.84
| Professional | 26 | $8.25 | $9.44 | $9.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.26 / $25.57 / $27.74
| Professional | TC | $22.26 | $25.57 | $27.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.00 / $53.00 / $53.00
| Facility | 26 | $53.00 | $53.00 | $53.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.62 / $50.00 / $170.27
| Professional | | $41.62 | $50.00 | $170.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.40 / $11.40 / $35.15
| Professional | 26 | $11.40 | $11.40 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.68 / $32.68 / $39.79
| Professional | TC | $32.68 | $32.68 | $39.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $58.40 / $170.27
| Professional | | $40.65 | $58.40 | $170.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.43 / $12.12 / $35.15
| Professional | 26 | $11.43 | $12.12 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.18 / $39.29 / $67.77
| Professional | TC | $28.18 | $39.29 | $67.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.86 / $51.33 / $170.27
| Professional | | $38.86 | $51.33 | $170.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.79 / $12.12 / $35.15
| Professional | 26 | $11.79 | $12.12 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.62 / $37.29 / $67.77
| Professional | TC | $26.62 | $37.29 | $67.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.09 / $49.15 / $147.38
| Professional | | $38.09 | $49.15 | $147.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.97 / $12.45 / $37.40
| Professional | 26 | $8.97 | $12.45 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.78 / $39.13 / $143.72
| Professional | TC | $26.78 | $39.13 | $143.72 |