- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.68 / $81.51 / $87.46
| Professional | | $70.68 | $81.51 | $87.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.55 / $12.53
| Professional | 26 | $7.33 | $8.55 | $12.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $63.35 / $72.75 / $78.90
| Professional | TC | $63.35 | $72.75 | $78.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.85 / $49.85 / $49.85
| Facility | 26 | $49.85 | $49.85 | $49.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.88 / $56.88 / $182.67
| Professional | | $56.88 | $56.88 | $182.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.36 / $15.36 / $63.29
| Professional | 26 | $15.36 | $15.36 | $63.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.14 / $36.14 / $36.14
| Professional | TC | $36.14 | $36.14 | $36.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.40 / $94.12 / $182.67
| Professional | | $62.40 | $94.12 | $182.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.55 / $20.69 / $63.29
| Professional | 26 | $11.55 | $20.69 | $63.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.94 / $59.66 / $140.41
| Professional | TC | $40.94 | $59.66 | $140.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.40 / $94.12 / $182.67
| Professional | | $62.40 | $94.12 | $182.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.31 / $20.90 / $63.29
| Professional | 26 | $11.31 | $20.90 | $63.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.94 / $54.06 / $119.02
| Professional | TC | $40.94 | $54.06 | $119.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.06 / $94.59 / $158.33
| Professional | | $43.06 | $94.59 | $158.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $19.89 / $67.31
| Professional | 26 | $10.80 | $19.89 | $67.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.29 / $65.20 / $126.99
| Professional | TC | $27.29 | $65.20 | $126.99 |