- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $40.74 / $102.33
| Professional | | $26.92 | $40.74 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $8.91 / $33.11
| Professional | 26 | $6.76 | $8.91 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $32.36 / $81.28
| Professional | TC | $20.89 | $32.36 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | 26 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $169.82
| Professional | | $41.69 | $41.69 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $11.48 / $35.48
| Professional | 26 | $11.48 | $11.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.36 / $32.36 / $39.81
| Professional | TC | $32.36 | $32.36 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $51.29 / $123.03
| Professional | | $38.02 | $51.29 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $12.59 / $29.51
| Professional | 26 | $10.72 | $12.59 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $39.81 / $97.72
| Professional | TC | $26.92 | $39.81 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $169.82
| Professional | | $36.31 | $36.31 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $9.55 / $35.48
| Professional | 26 | $9.55 | $9.55 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Professional | TC | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $46.77 / $138.04
| Professional | | $38.02 | $46.77 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $11.48 / $27.54
| Professional | 26 | $8.91 | $11.48 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $33.11 / $109.65
| Professional | TC | $26.92 | $33.11 | $109.65 |