- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $33.11 / $79.43
| Professional | | $12.02 | $33.11 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $19.95 / $50.12
| Professional | 26 | $7.08 | $19.95 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.03 / $22.39 / $39.81
| Professional | TC | $6.03 | $22.39 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Facility | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $51.29 / $177.83
| Professional | | $43.65 | $51.29 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $18.62 / $63.10
| Professional | 26 | $15.85 | $18.62 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $27.54 / $32.36
| Professional | TC | $27.54 | $27.54 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $29.51 / $123.03
| Professional | | $22.91 | $29.51 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $12.88 / $42.66
| Professional | 26 | $10.72 | $12.88 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $17.78 / $81.28
| Professional | TC | $11.75 | $17.78 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $177.83
| Professional | | $19.05 | $19.05 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $8.13 / $63.10
| Professional | 26 | $8.13 | $8.13 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.96 / $10.96 / $10.96
| Professional | TC | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $44.67 / $147.91
| Professional | | $29.51 | $44.67 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $17.78 / $51.29
| Professional | 26 | $10.23 | $17.78 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $28.18 / $95.50
| Professional | TC | $16.98 | $28.18 | $95.50 |