- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.14 / $20.02 / $41.07
| Professional | | $17.14 | $20.02 | $41.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.03 / $8.22 / $12.03
| Professional | 26 | $7.03 | $8.22 | $12.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.11 / $11.63 / $25.55
| Professional | TC | $10.11 | $11.63 | $25.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.71 / $47.71 / $47.71
| Facility | 26 | $47.71 | $47.71 | $47.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.37 / $51.12 / $178.27
| Professional | | $43.37 | $51.12 | $178.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.87 / $18.71 / $63.16
| Professional | 26 | $15.87 | $18.71 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.49 / $27.49 / $27.49
| Professional | TC | $27.49 | $27.49 | $27.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.80 / $46.53 / $178.27
| Professional | | $22.80 | $46.53 | $178.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.86 / $18.55 / $63.16
| Professional | 26 | $10.86 | $18.55 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.66 / $16.73 / $61.28
| Professional | TC | $11.66 | $16.73 | $61.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.80 / $29.65 / $178.27
| Professional | | $22.80 | $29.65 | $178.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.83 / $12.92 / $63.16
| Professional | 26 | $10.83 | $12.92 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.65 / $15.60 / $61.28
| Professional | TC | $11.65 | $15.60 | $61.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.32 / $55.94 / $189.63
| Professional | | $29.32 | $55.94 | $189.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.23 / $20.55 / $59.89
| Professional | 26 | $8.23 | $20.55 | $59.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.91 / $35.39 / $122.44
| Professional | TC | $16.91 | $35.39 | $122.44 |